[size=20px]Given an equivalent length of remaining intestine, which of the following etiologies of intestinal failure / short bowel syndrome in infancy has a higher likelihood to attain enteral autonomy?

A jejunal atresia

B gastroschisis

C necrotizing enterocolitis

D volvulus

E cystic fibrosis[/size]

"Surgery is indicated only for selected patients with any one of three conditions: (1) when the absorptive surface area is definitely too small to allow enteral feeding; (2) when severe dysmotility in grossly dilated loops entails stagnation of chyme; and (3) when intestinal transit time is too fast to allow sufficient absorption of nutrients. In the first group of patients, intestinal transplantation is the mainstay of surgical therapy. In the second group, peristalsis can be improved by intestinal tapering or tapering and lengthening. In the third group, antiperistaltic segments, colonic interposition, intestinal valves, and/or artificial invagination have been used in selected patients."

"Resection of the jejunum is well tolerated owing to the enormous adaptive capacity of the ileum, the intact enterohepatic circulation of bile salts, and the preserved absorption of fat-soluble vitamins and vitamin B12. In contrast, if the entire ileum is lacking, absorption of nutrients is significantly more difficult because of the limited intestinal adaptation capacities of the jejunum. Nonabsorbed intestinal contents, including bile acids, spill over into the colon and may cause significant diarrhea. Furthermore, loss of the ileum leads to a reduction of the bile salt pool, malabsorption of fat and fat-soluble vitamins, and a vitamin B12 deficiency."

"The pathophysiological process that follows an extensive loss of small bowel is called intestinal adaptation. It includes (1) morphological changes leading to an increase of absorptive surface area, (2) functional changes resulting in augmentation of the absorptive capacity of the remaining enterocytes, and (3) increased intestinal diameter with a concomitant reduction of motility, thereby slowing down the intestinal transit time of chyme."

"The presence of intraluminal food is the most important driving force for intestinal adaptation. Enteral nutrients stimulate gastrointestinal secretions and hormones that are known to exert trophic effects on the mucosa. Recent evidence suggests that glucagon-like peptide 2, human growth hormone, epidermal growth factor, and insulin-like growth factor I may play an important role in the process of intestinal adaptation."

"The term “short bowel” was defined by Rickham in 1967 as a small intestinal remnant of 75 cm or less in the newborn, which equals 30% of normal small bowel length in that age group. A more functional description, preferred by most authors, defines a “short bowel syndrome” (SBS) as a state of significant maldigestion and malabsorption due to an extensive loss of functional absorptive intestinal surface area."

Edit: available without restrictions

[center][/center]

[size=20px]The most reasonable next approach to increase his ability to tolerate enteral feedings is

A serial transverse enteroplasty.

B intestinal transplantation.

C jejunal feeds.

D use of teleglutide.

E intravenous antibiotics.[/size]