Intestinal adaptation after extensive resection of the small intestine and prolonged administration of parenteral nutrition.

After a superior mesenteric thrombosis in a 77 year old man, all but 24 centimeters of the jejunum were resected and anastomosed to the remaining left colon. After being maintained on parenteral nutrition on a 24 hour basis for six weeks, the patient was placed on overnight parenteral nutrition in which he received 2 liters of parenteral nutrition solution containing about 2,200 calories. Over a period of nine months, hypertrophy, lengthening and dilatation took place so that the patient was almost able to support himself by mouth. We believe that this is the first patient in whom documented lengthening of the small intestine has been reported. The factors entering into the hypertrophy and dilatation are discussed. Many patients in this age group are denied therapy because of the consequences of massive enterectomy. With adaptation using prolonged parenteral nutrition, it should be possible for most patients to sustain themselves completely by mouth. Patients with massive necrosis of the small intestine should not be denied therapy even if only 1 foot of small intestine remains. This is likely to hypertrophy in length until parenteral nutrition is no longer necessary.