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Nutrition in Clinical Practice
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Clinical Observations

Practical Guide to Intestinal Rehabilitation for Postresection Intestinal Failure: A Case Study

Laura E. Matarese, MS, RD, LDN, FADA, CNSD*, Douglas L. Seidner, MD, FACG, CNSP{dagger},{ddagger}, Ezra Steiger, MD, FACS, CNSP{ddagger} and Victor Fazio, MB, MS, FRACS, FACS, FRCS§

* Intestinal Rehabilitation and Transplant Center, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and the{dagger} Department of Gastroenterology,{ddagger} Department of General Surgery, and§ Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio

Correspondence: Laura E. Matarese, MS, RD, LDN, FADA, CNSD, Director of Nutrition, Intestinal Rehabilitation and Transplant Center, Thomas E. Starzl Transplantation Institute, UPMC Montefiore, 7 South, 3459 Fifth Avenue, Pittsburgh, PA 15213. Electronic mail may be sent to mataresele{at}upmc.edu.

After massive small-intestinal resection or combined small-intestinal and colonic resection, diarrhea with resulting dehydration, electrolyte abnormalities, and malnutrition occur. Many patients become dependent on IV fluids and nutrition. An adaptation process manifested clinically by decreased diarrhea and improved nutrient absorption according to decreased parenteral nutrition and fluid requirements has been noted to occur over time. In some patients, adaptation is inadequate and may require special techniques to enhance and augment this process. This is a case of a 52-year-old woman who experienced increased stoma output 1 week after major intestinal resection, resulting in dehydration. She required IV fluids in order to maintain hydration. After the initiation of an intestinal rehabilitation program, which included modified diet, soluble fiber, oral rehydration solution (ORS), and medications, IV fluids were successfully weaned off in 3 months. She continues not to receive IV fluids and continues to follow the intestinal rehabilitation plan.

Nutrition in Clinical Practice, Vol. 20, No. 5, 551-558 (2005)
DOI: 10.1177/0115426505020005551
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Related articles in Nutrition in Clinical Practice:

Short Bowel Syndrome: Clinical Guidelines for Nutrition Management
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Nutrition in Clinical Practice 2005 20: 493-502. [Abstract] [Full Text]