The Role of Nutrition in the Adaptation of the Small Intestine After Massive Resection

Abstract

Background: The demonstration that weight gain, growth, and development can be achieved by supplying all essential nutrients exclusively by vein prompted the laboratory evaluation of this parenteral feeding technique in animals that had undergone enterectomy. This study was undertaken to determine the role of nutrition and anabolism in compensation of the small intestine after massive intestinal resection. Methods: Three or 4 littermate beagle puppies from 10 litters, obtained 8 weeks after weaning and weighing 2 to 3 kg, underwent enterectomy at 10 weeks of age. In the standardized operation, 90% or 95% of the small intestine was removed, as measured from the tail of the pancreas to the ileocecal junction. After enterectomy, the dogs were divided into 2 groups, 1 group being fed exclusively with a kennel diet and the other offered the orally administered diet, whereas all the required nutrients were by vein. After 1 month of continuous infusion, the puppies were weaned from the IV-administered nutrient solution and maintained solely on the standard, orally administered diet. Results: Thirty-four puppies were evaluated for up to 1 year with their control littermates with no resection. Normal growth and development occurred in all puppies after enterectomy during the total IV administration of nutrition. After the parenteral feeding, the dogs with a 90% resection achieved near normal weight gain in contrast to the orally fed dogs with enterectomy that grew to only one-half normal size. In the 95% resected group, 5 of 6 dogs survived more than 4 months after parenteral feedings, whereas only 1 of 5 lived more than 1 month while receiving oral feedings alone. At 1 year, the intestine from the parenterally fed dogs that had undergone enterectomy demonstrated increased mucosal cellularity, marked villus hypertrophy, and increased intestinal weight gain per unit length when compared with the orally fed dogs that had undergone resection and the control littermates. Conclusions: By providing all essential nutrients by vein for 30 days, significant improvement in survival, growth, and nutrition was noted in puppies after massive intestinal resection.