Combined oral and home parenteral nutrition for the short bowel syndrome.

Combined parenteral and peroral nutrition is necessary when a large small bowel resection leads to inadequate intestinal absorption and starvation. We report the case of a 17-year old schoolgirl in whom, following a rupture of the spleen and splenectomy, extensive small bowel necrosis necessitated small bowel resection from the lig. Treitz to the terminal ileum saving the last ten centimeters of the ileum. The serious starvation which developed after the operation was first treated with a one-month course of parenteral nutrition in hospital. Thereafter the patient took care of the infusions herself. Home parenteral nutrition took place during a 10-12 h overnight period 5 times a week. The proportion of peroral dietary intake was increased gradually during the first year, after which a 1 to 1 ratio between peroral and parenteral intake of energy and protein was maintained. The patient's subjective and objective well-being after two-years' of follow-up is good. Regular examinations at 3-6 month intervals are needed for the maintenance of adequate nutritional replacement.