Limited ileal resection in infancy: The long-term consequences

Background/Purpose: The longer-term sequelae of short bowel syndrome in inf ancy are reasonably well documented, but little is known about the long-ter m nutritional and metabolic effects of limited (less than 50 cm) ileal rese ction. This makes it difficult to formulate a rational follow-up policy in such children. Methods: All children who underwent limited ileal resection for either necr otizing enterocolitis (NEC) or intussusception at our institution between 1 984 and 1992 were invited to attend a detailed clinical, anthropometric, he matologic, and biochemical assessment, together with a biliary and renal ul trasound scan and measurement of bone mineral density. Results: Twenty-four children ( NEC, 17; intussusception, 7) of median age 7.4 years (range, 5.5 to 13.7 years) agreed to participate. Nine previously had undergone an isolated ileal resection, and 15 also had had variable le ngths of colon removed. The length of resected ileum ranged from 3 to 44 cm , with a median of 10 cm. Seven control subjects in whom neonatal NEC devel oped but recovered without surgery were also evaluated. Median height, weig ht, and body mass index after ileal resection were between the 25th and 50t h percentiles; no child was stunted or wasted. After ileal resection, one b oy was found to have asymptomatic vitamin Bit deficiency, and three childre n had low plasma concentrations of vitamin A. Hematologic and biochemical p arameters were otherwise normal apart from a few marginally low trace eleme nt levels in both subjects and controls. No renal calculi were detected, an d bone mineral density measurements were normal in all except one child. Fo ur children had cholelithiasis, all of whom had previously undergone limite d ileal resection for NEC (two isolated, two ileocolic). Thus, the prevalen ce of cholelithasis after limited ileal resection for NEC was 24% at a medi an age of 7.0 years. Conclusions: Growth and nutritional status are well preserved after limited ileal resection in infancy. Limited ileal resection for NEC is associated with a subsequent high prevalence of cholelithiasis and a risk of vitamin B -12 deficiency. These findings are important when planning strategies for l ong-term follow-up. Copyright (C) 1999 by W.B. Saunders Company.