Treatment for pediatric short bowel syndrome with chronic kidney disease

Abstract

The patient was a 1‐year‐old boy. He was born at 24 weeks and 3 days of gestation with a birth weight of 662 g. At 3 months of age (corrected age: 27 weeks), he underwent extensive small bowel resection and ileostomy for midgut volvulus caused by intestinal malrotation, leaving 20 cm of residual small intestine. The patient experienced prolonged liver dysfunction, jaundice, and renal impairment, as well as poor weight gain and multiple fractures of the extremities. He was transferred to our hospital for long‐term nutritional management.
The patient was 1 year and 3 months old (corrected age: 7 months) at the time of admission and his weight was 3.5 kg. X‐rays showed multiple fractures of the extremities. Laboratory findings showed malnutrition, hypocalcemia, and renal dysfunction (serum parathyroid hormone level, 1174.2 pg/mL). He was diagnosed with secondary hyperparathyroidism associated with malabsorption due to short bowel syndrome and renal impairment.
Post‐admission, the patient was treated for secondary hyperparathyroidism by adjustments to calcium and phosphate supplementation, as well as an increased dose of total parenteral nutrition. After 3 months of hospitalization, his weight increased to 5.71 kg, and his electrolyte imbalances resolved. We initiated a treatment plan that includes continued nutritional management aimed at promoting further weight gain.