Shanmugam Dasarathan

Background: Short bowel syndrome (SBS) is a condition where a significant portion of the small intestine is lost/ absent, either congenitally or secondary to surgical resection. Complications arising due to the short length of the remnant bowel account for the high morbidity and mortality. In this case series, we describe our experience with 23 patients who underwent major intestinal resection. Methods: Retrospective data were retrieved from departmental records from January 2017 to June 2024 of patients who underwent major small bowel resection at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry with a remnant small bowel length of <200cm. Results: After excluding patients with incomplete records, data from 23 patients were analyzed. Mesenteric ischemia due to thrombosis of the superior mesenteric artery or vein was the most common etiology behind massive bowel resection. Most of the patients required intensive care in the immediate postoperative period, with ventilator support. The wound related complications included superficial and deep surgical site infection (52.2%), wound dehiscence (21.7%), and stomal necrosis (26.1%). Dyselectrolytemia, in the form of hyponatremia, was common in Type I (90%) and Type II SBS (80%), whereas it had a lower incidence in Type III SBS (28.6%), p value = 0.023. Early postoperative mortality occurred in 5 patients. Conclusions: The present case series shows the high morbidity and mortality associated with massive small bowel resection. Early initiation of enteral feeds, with or without parenteral supplementation, may help prevent dependence on parenteral nutrition and is associated with lower morbidity and mortality.

Acute corrosive injury most commonly affects the upper aerodigestive tract and may necessitate emergency surgery in a minority of cases when transmural necrosis develops. The present case manifested with multiorgan dysfunction and subsequently deteriorated, developing acute peritoneal signs that required emergency surgical intervention. Intraoperatively, the distal thoracic esophagus and proximal stomach appeared unexpectedly viable; however, there was extensive transmural circumferential gangrene involving the distal stomach, duodenal C-loop, and proximal jejunum. A surgical decision between pancreatoduodenectomy and pancreas-sparing duodenectomy was required. Given the patient’s poor general condition and hemodynamic instability, pancreas-sparing duodenectomy with ampullo-jejunal anastomosis was performed. Although the postoperative course was complicated, the patient gradually recovered and was discharged on an oral liquid diet. This report outlines the complexities associated with such atypical presentations and emphasizes the importance of individualized surgical decision-making and multidisciplinary postoperative care in the comprehensive management of acute corrosive injuries.