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Summary Background & aims Children on home parenteral nutrition and their parents not only engage with complex nutritional issues but also have to manage difficult social and financial problems with social and clinical support that may not always meet their needs. Baxter's HPN-QOL questionnaire, assesses the QOL of adult patients treated with HPN, and has been developed rigorously using standard guidelines, measuring various dimensions of QOL. Our aim was to use this tool to explore how HPN influences the QOL of paediatric patients. Methods The HPN-QOL questionnaire was modified to suit a paediatric HPN population. Data on demographics, aetiology of intestinal failure and duration of HPN were collected from a departmental database. Quality-of-Life grading of functional and symptom scales, HPN specific items and overall QOL Numerical Rating Scales were determined. Results Fourteen out of 17 families returned the completed questionnaires. QOL was significantly impaired by increased dependency regarding items of daily living such as eating, dressing, washing, and mobility, but was not affected in the domains of school attendance, general fatigue, pain and body image. There were no significant differences in QOL when patients with and without enterostomy were compared. Patients felt well supported by the hospital nutrition team in managing logistics related to HPN. Conclusions QOL in HPN patients was not significantly affected by the medical aspects of care. This descriptive study highlights the need for further integration of medical and social care in order to support families of children receiving HPN as QOL was impaired in relation to activities of daily living and social functioning.

Small bowel disruption is often complicated by acute intestinal failure and can be corrected by chyme reinfusion (CR). Plasma citrulline ([Cit]) is a biomarker of the enterocyte mass. Our aim was to determine whether [Cit] could be a marker of absorptive intestinal mass or function by assessing whether CR could affect intestinal absorptive function and [Cit].Twenty-six patients with small bowel disruption and double enterostomy were treated with CR. Fecal wet weight, nitrogen and fat absorption, parenteral nutrition delivery and [Cit] were measured before and after the initiation of CR with a median follow-up of 30 days.CR decreased the intestinal wet weight output (median+/-IQ, 2384+/-969 vs. 216+/-242mLd(-1), P0.0001) and parenteral nutrition dependence (65% vs. 8%, P0.01). CR was associated with a rise in net nitrogen and fat digestive absorption and [Cit] (17.0+/-10.0 vs. 31.0+/-12.0micromolL(-1), P=0.0001). Before the initiation of CR, [Cit] correlated positively with the absorptive post-duodenal small bowel length (r=0.39, P=0.04), but not with the total post-duodenal small bowel length (r=0.11, P=0.60).CR allows for a dramatic improvement of intestinal absorptive function and a near doubling in [Cit] level. [Cit] is not a marker of overall intestinal mass, but of the absorptive small bowel function.

The small bowel is subject to a variety of surgical interventions for the treatment of a broad spectrum of disease processes. Most operative procedures applied to the small bowel are straightforward techniques encumbered by few complications, whereas other procedures are considerably more complex and can be associated with significant postoperative morbidity. Familiarity with the anatomic alterations related to the various operations is essential, both for evaluation of early postoperative complications and those abnormalities that manifest late in the postoperative course. The surgeon and radiologist should carefully coordinate clinical suspicion with the strengths of the various imaging modalities to optimize postsurgical assessment and provide timely and accurate diagnosis. Enteric anastomoses, the different forms of enterostomy, and the varied constructions of small bowel pouches and reservoirs are each associated with unique anatomy and therefore optimal techniques of assessment. Small bowel contrast studies such as enteroclysis--including its recent modification, CT enteroclysis--and CT imaging represent the primary modalities for imaging of the postoperative bowel and its related abnormalities. Small bowel transplantation continues to progress as a realistic treatment for intestinal failure, and the role of diagnostic imaging in these unique and challenging patients is evolving.

27 patients were admitted in the Digestive intensive care unit of Croix-Rousse Hospital after a massive bowel resection (residual bowel 120 cm). The etiology was of vascular origin in 15 cases. The length of intestine was nil in 4 cases, between 20 and 50 cm in 12 cases, and between 50 and 120 cm in 11 cases. A colon resection was performed in 20 cases. For 5 patients, a "double temporary intestinal stoma" for ischemic bowel was made. A "second look laparotomy" was performed in 11 cases. The definitive intestinal continuity restauration was made in 23 cases (7 immediately, 16 later) with 3 duodenocolic anastomoses. 8 patients were able to find back a oral alimentation. 19 patients (with 4 total bowel resections) received a home parenteral nutrition. Actually, 11 are alive.

This retrospective study analyzes the management of 83 infants who had undergone extensive small bowel resection as newborns between 1970 and 1987. Resection was performed for atresia (n = 34), volvulus (n = 21), laparoschisis (n = 10), vascular enteropathy (n = 10) and other disorders in 8 cases. The patients were divided into two groups: Group I (33 children) has less than 40 cm and Group II (50 children) 40-80 cm of residual small bowel respectively. Survival depended on the length of residual small bowel (Group I: 63.6%, Group II: 92%) and on their date of birth (born before 1980: 65%, after 1980: 95%). The time required for acquisition of intestinal autonomy depended on the intestinal length (average time, 29.5 months for Group I and 14 months for Group II) and especially on the presence of the ileocecal valve. The residual ileal and/or colon length also influenced adaptation. Artificial parenteral and/or enteral nutrition ensured normal height/weight increases. Home parenteral nutrition allowed children to be returned to their families during intestinal adaptation.