Intestinal failure (IF) exists when a patient cannot maintain their fluid balance and nutritional needs independently through the enteral route (i.e. orally). This is due to a loss of functioning gut. In most patients this loss of function is temporary, for example, immediately following abdominal surgery when intravenous fluids and or PN are required until gastrointestinal function returns. This resolves without any long-term sequelae. However, some patients develop a long-term reduction in functioning intestine. The management of these cases is complicated and care under a specialist multidisciplinary team maximizes the likelihood of an optimum outcome. Some of these patients may require long-term intravenous nutrition or bowel transplantation. Shaffer recently set out a classification of IF identifying the differences in duration and severity.
Type 1 – self-limiting IF as occurs following abdominal surgery
Type 2 – IF in severely ill patients with major resections of the bowel, with septic, metabolic and nutritional complications requiring multidisciplinary intervention with metabolic and nutritional support to permit recovery
Type 3 – chronic IF requiring long-term nutritional support.
Such a devastating condition has a huge impact on their lives and ability to live independently as well as considerable cost and resource implications for the healthcare provider. In the UK there are several supra-regional centres caring for these patients.
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