Short-bowel syndrome and intestinal failure — branching viva

Opening — framing the problem

The examiner begins: a baby born at 27 weeks develops necrotising enterocolitis and undergoes a massive small-bowel resection, leaving a 35-centimetre jejunal remnant ending in a jejunostomy with the colon disconnected. The stoma output is 60 mL/kg/day and the weight has fallen. Talk me through your approach. ^[1]

I would frame this as intestinal failure from short-bowel syndrome, with the end-jejunostomy configuration the single most important prognostic feature. My priorities would be to stabilise the child on parenteral nutrition, to actively measure and replace the sodium-rich stoma losses, to start trophic enteral feeding to drive adaptation, to protect the immature liver by a lipid and sepsis strategy, and to involve the intestinal rehabilitation team early, because the loss of colon continuity puts this child at high risk of needing a prolonged programme and possibly transplant. ^{[1] [2]}