Short bowel syndrome in patients studied at the National Institute of Pediatrics in Mexico. Care, cost and perspectives

Background: Short bowel syndrome (SBS) continues to be one of the most chal lenging problems in pediatric surgery. Intestinal transplantation (IT) seem s to be the best form of treatment for this pathology. However, it is thoug ht that the development of an IT program may be more expensive than the pre sent manner of treatment. Methods: To assess this item, and to identify potential candidates for IT, we reviewed the charts of all the patients with SBS treated at our Institut e from 1989 to 1994. Result: Nine patients were identified as carriers of SBS; six with intestin al atresia, two with midgut volvulus and one with post-traumatic mesenteric thrombosis. The small bowel remnants varied from 1 to 80 cm, seven patient s had remnants shorter than 30 cm, and the ileocecal valve was resected in three. Results: The overall morbidity and mortality was extremely high; fou r patients died within the first 3 months postresection and those still ali ve have had several complications: sepsis; hydroelectrolyte imbalances seco ndary to loose stools; thrombosis or infection of the catheter; TPN-related cholestasis, and malabsorption syndromes, etc. No patient survived with an intestinal remnant shorter than 15 cm. Of the five survivors, four have a weight/age deficit greater than 40%, two have rickets, one still depends on TPN and all, except one, require special enteral diets. Multiple central v enous accesses had to be performed in every patient (mean 4.8). They all re quired multiple readmissions and have spent a considerable part of their li ves as inpatients. The mean of the calculated cost per patient was $50,000 USD, while the minimal wage in Mexico is $1,616 USD/year (1). Conclusions: The shorter the segment of the retained bowel and the longer t he survival, the higher the cost. These results may be further improved wit h the development of IT and, probably, with the same economic burden.