CHALLENGES AND CARE IN PALLIATIVE MEDICINE: A CASE REPORT OF A CHILD WITH SHORT BOWEL SYNDROME
Abstract
Pediatric palliative care has become an essential approach in managing complex chronic conditions, especially those associated with malnutrition, such as Short Bowel Syndrome (SBS). The objective of this study is to present the case of a child with SBS within pediatric palliative care, emphasizing the complexity of clinical management and the importance of a multidisciplinary approach. This is a retrospective analysis of medical records, focusing on clinical evolution, therapeutic interventions, and nutritional support. We report the case of a nine-year-old male patient, weighing 13 kg, with non-progressive chronic encephalopathy and severe malnutrition, admitted with abdominal pain and distension associated with hyporexia. He had a history of chronic constipation and recurrent ingestion of foreign bodies. He developed clinical instability, requiring orotracheal intubation and vasoactive drugs. Computed tomography revealed jejunal distension, a foreign body in the rectal ampulla, and signs of subocclusion. Exploratory laparotomy confirmed obstructive acute abdomen due to internal hernia and bezoar, and segmental enterectomy with enteroenteric anastomosis was performed. He developed anastomotic dehiscence and peritonitis, requiring six surgical reinterventions, culminating in severe SBS with insufficient intestinal remnant for enteral nutrition. He remained on total parenteral nutrition and presented recurrent sepsis, enteric fistulas, thrombosis, and progressive loss of venous access. Given the irreversibility of the condition and the unfeasibility of intestinal transplantation, palliative care was instituted. The patient died ten months after admission, three months under palliative care. This case highlights the complexity of SBS and palliative care in pediatrics, reinforcing the importance of multidisciplinary comprehensive care.
Author Biographies
Discente de Medicina - Faculdade Afya Medicina de Itajubá, Itajubá-MG, Brasil.
Discente de Medicina - Faculdade Afya Medicina de Itajubá, Itajubá-MG, Brasil.
Médica Pediatra e Nutróloga, Docente de Medicina - Faculdade Afya Medicina de Itajubá, Itajubá-MG, Brasil.
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