A description of the management and outcomes of children with intestinal failure in a South African context

Abstract

Abstract Background Intestinal failure as a result of congenital or acquired massive bowel loss is an extremely difficult problem to manage and has traditionally been associated with a very poor outcome. In this study, the aim was to describe the current management of this problem, give an updated estimate of the survival and a description of the factors associated with survival and achievement of enteral autonomy in our context. Methods: A retrospective chart review was done for children managed with intestinal failure at Inkosi Albert Luthuli Central Hospital, South Africa from November 2015 to February 2023. Results: Twenty-two patients were managed with intestinal failure during the study period. The diagnosis was type 4 jejunal atresia with 3b component in 5 (22.7%); type 3b jejunal atresia in 5 (22.7%); type 4 jejunal atresia without 3b component in 3 (13.6%) and malrotation with volvulus in 3 (13.6%). One patient each had necrotizing enterocolits, gastroschisis with atresia, intussusception, type 1 jejunal atresia with volvulus, type 3a jejunal atresia and volvulus around an ileostomy. Average bowel length was 34.7cm, and average length of stay was 122 days. Enteral autonomy was achieved in 10 patients (45%) and survival in 9 patients (41%). Surgical complication requiring early re-operation (OR 18) and bowel length equal to or less than 20cm were associated with non-survival. Conclusion A substantial proportion of children with intestinal failure can achieve enteral autonomy and survival in our context. The treatment process is, however, resource intensive. Avoiding early re-operation and bowel length >20cm are associated with a good outcome.