Clinical Manifestations of Micronutrient Deficiencies in Short Bowel Syndrome: A Case Report

• Type of Material: Article
• Authors: Diana N Rodriguez, University of Florida Health Shands Hospital; Nicole C Ruiz, Emory University; Steve Qian, University of Florida Health Shands Hospital; Amir Y Kamel, University of Florida Health Shands Hospital
• Language: English
• Date: 2023-04-20
• Publisher: Cureus, Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2023, Rodriguez et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.7759/cureus.37897
• Title of Journal or Parent Work: Cureus
• Volume: 15
• Issue: 4
• Keywords: sma stenting; short bowel syndrome; citrulline; malnutrition; sma occlusion; total parenteral nutrition (tpn); sma ischemia
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Pharmacy

Abstract

The etiologies of short bowel syndrome (SBS) can be stratified into congenital or acquired etiologies, with the latter being more prevalent. Small intestinal surgical resection is the most common acquired etiology, employed in settings including mesenteric ischemia, intestinal injury, radiation enteritis, and inflammatory bowel disease (IBD) complicated by internal fistulas. We describe a case of a 55-year-old Caucasian male with a history of idiopathic superior mesenteric artery (SMA) ischemia post-SMA placement complicated by recurrent small bowel obstructions. He presented with SMA stent occlusion and infarction, leaving him with 75 cm of post-duodenal small bowel after emergent surgical resection. He was trialed on enteral nutrition and progressed to parenteral nutrition (PN) after failure to thrive. With intensive counseling, his compliance improved, and he was able to briefly maintain adequate nutrition status with supplemental total parenteral nutrition. After a period of being lost to follow-up, he succumbed to complications from untreated SBS. This case highlights the need for intensive nutritional support for patients with short bowel syndrome and awareness of clinical complications.