Acute short bowel syndrome following massive small bowel resection in a strangulated right paraduodenal hernia in a lower income-setting: a case report

Introduction and Importance: Short bowel syndrome (SBS) is a serious complication following extensive intestinal resection. It is rarely reported in Africa, probably due to the high mortality rate in the acute phase. This article reports a case of acute SBS that was successfully managed. Case Presentation: A 60-year-old female patient was admitted for an occlusive syndrome with shock that had been developing for 4 days. A CT scan revealed a right paraduodenal hernia complicated by intestinal necrosis. Surgical exploration found 450 cm of necrotic small intestine incarcerated in the hernia. After resection, 130 cm of proximal jejunum and 15 cm of terminal ileum remained. A gunshot ileostomy was performed. The postoperative period was marked by hyponatremia, weight loss, hyperproductive stoma, skin irritation, and a buttock bedsore. Treatment included parenteral nutrition (Perikabiven), transit retardants, proton pump inhibitors, enteral nutrition, oral rehydration salts, and Plumpy’nut. Digestive continuity was restored on day 26, with postoperative complications including deep venous thrombosis and an enterocutaneous fistula treated medically. The patient was discharged 12 days later, treatment was continued at home except for Perikabiven, and the fistula healed on day 37. Clinical Discussion: Strangulated internal hernias are a rare cause of SBS. Type III, jejuno-ileo-colonic anastomosis has a favorable prognostic factor in the acute phase. This phase is marked by significant fluid and electrolyte losses, causing diarrhea, dehydration, and electrolyte disturbances. This phase is characterized by the need for constant fluid resuscitation and nutritional intake. It requires early detection, rigorous monitoring, and pragmatic adaptation of nutritional strategies to available means. Conclusion: SBS is a serious complication of major intestinal resection, especially in the acute phase. It increases the burden of hospital care in settings with limited resources. It requires early detection, rigorous monitoring, and pragmatic adaptation of nutritional strategies to available means.