A difficult abdominal case

[Dr. Haim Paran]

We had over the last 15 years 5 or 6 patients treated with home TPN for
life. One patient survived 16 years, the others were older and lived between
3 and 10 years on such treatment. All patients had line problems, and
eventually needed replacement of the IV line every 3 to 12 months. The most
important thing to prevent line sepsis/occlusion/dislodgement etc is
adequate handling of the equipment and strict adherence to the aseptic rules
in handling the equipment.
Usually they also developed electrolyte/vitamins/trace-elements problems but
these can be quite easily corrected.
A specialized team must be available to treat these patients. We have a
protocol which I can send you.
We had success with another 2 patients who had 60 cm of jejunum left after
the resection. They were sent home on TPN, but later after their general
condition improved we started a combined treatment enteral glutamine, growth
hormone and elemental diet. Both patients were able to gradually switch to
enteral feeding, and eventually did not need TPN anymore. Sometimes they
don't comply with their diet and have severe diarrhea. In this case the best
treatment is to start TPN again and over the next 3 or 4 weeks, start again
gradually with the strict elemental diet.
All these patients need continuous close follow-up.

Good luck,

Haim Paran
Dept. of Surgery
Meir Medical Center
Kfar-Sava, Israel 

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of nappio at aol.com
Sent: Friday, July 11, 2008 4:32 PM
To: Trauma & Critical Care mailing list
Subject: Re: A difficult abdominal case

How about small bowel transplant? Dn
------Original Message------
From: Timothy Craig Hardcastle
Sender: trauma-list-bounces at trauma.org
To: Trauma & Critical Care mailing list
ReplyTo: Trauma & Critical Care mailing list
Sent: Jul 11, 2008 09:10
Subject: RE: A difficult abdominal case

Dr Khattar

A number of first-world countries offer long-term home TPN, however, I
do not know the life expectancy of the patients. Maybe one of our
learned first-world colleagues will answer that for you!

Tim
Dr Timothy C Hardcastle
M.B., Ch.B. (Stell); M. Med (Chir) (Stell); FCS (SA)
Principal Surgeon-Lecturer / Sub-specialist: Trauma and Critical Care
Deputy director: Trauma Unit and Trauma ICU
Inkosi Albert Luthuli Central Hospital / UKZN
800 Bellair Road
Mayville, Durban
 
Postal: PostNet Suite 27
Private Bag X05
Malvern, 4055
KwaZulu Natal
 
timothyhar at ialch.co.za 
 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of rm khattar
Sent: 11 July 2008 14:01
To: trauma-list at trauma.org
Subject: A difficult abdominal case

Although we did consider closing abdomen without resection,but ended up
doing resection of entire SB,Right colon,doing a end jejunostomy,and
closing the end of transverse colon and leaving it in the abdomen,he
rapidly recovered with normalization of renal and hepatic parameters,
and resumption of oral liquids,and movement of jejunostomy.He was put on
TPN.The probable cause is SMA thrombosis.
Dr Timothy,Where on earth life long home TPN is available and how much
one can live on such treatment ?  


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