The Challenges of Managing and Following-up a Case of Short Bowel Syndrome in Eastern Europe - Abstract
The problems faced by hospitals in the developing countries and how they handle difficult and complex cases as in short bowel syndrome is usually not discussed in international journals. The aim of this paper is to attract attention to the plight of patients with rare and complex diseases in Eastern Europe. Data’s were collected and analyzed from 3 different hospitals in two different countries from November 2013 to 2016. Patient had an emergency surgery for intestinal malrotation (volvulus), as a result of extensive ischemic necrosis, with just 80 cm of the bowel without ileocecal valves after surgery. The resultant short bowel syndrome symptoms forced parents to seek medical help in a bigger regional hospital. But despite intensive care and subsequent surgeries with just 70 cm of the intestine left, patient remained in catabolic state and was transferred to a neighboring western hospital where two more surgeries and intensive care helped patient to finally achieve enteral feeding at the optimal time. The collaboration between our hospitals and the pediatric unit across the border was the last hope that helped save this patient`s life at the last minute. The major problem is the lack of sufficient mucosal surface in order to gain enteral nutrition, as enteral feeding is tolerated TPN was gradually weaned proportionally, it should be noted that fluid and electrolyte imbalance is frequent during this process, so hydration and serum electrolyte level should be closely monitored and corrected promptly