Intestinal failure

Some persons are born with or develop irreversible intestinal failure. Intestinal failure occurs when the intestines cannot digest food and absorb the fluids, electrolytes and nutrients that are essential to life and normal development. Total parenteral nutrition (TPN) is then indicated, which provides liquid nutrition through a catheter or needle inserted into a vein in the arm, groin, neck or chest.
The most common cause of intestinal failure is short-bowel syndrome where at least half or more of the small intestine has been removed.  Short-bowel syndrome is typically a postsurgical condition for treatment of conditions such as trauma, necrotizing enterocolitis or midgut volvulus. Other causes are congenital malformations such as small=bowel atresia, gastroschisis, and aganglionosis.
Intestinal failure may also be caused by functional disorders such as Crohn's disease, chronic idiopathic intestinal pseudo-obstruction syndrome or absorptive impairment (e.g., intestinal pseudo-obstruction, microvillus inclusion disease). The conditions leading to intestinal failure are age-dependent. In summary:

I   Short-bowel syndrome

II   Congenital enteropathies

III   Intractable diarrhoea of infancy:

  • Congenital chronic diarrhoea with protein losing enteropathy
  • Microvillus inclusion disease
  • Epithelial dysplasia

IV   Rare diseases involving intestinal motility:

  • Chronic intestinal pseudo obstruction syndrome
  • Extended aganglionosis

Total parenteral nutrition (TPN)
Patients with intestinal failure may receive all or most of their nutrients and calories intravenously through total parenteral nutrition (TPN). Patients on TPN may live for many years, but long-term use of TPN can result in serious complications, such as bone disorders, central venous catheter infections and liver disease. If those complications become life-threatening, an intestinal transplant may be required.