University of California San Francisco

Intestinal Failure

Some persons are born with or develop irreversible intestinal failure.  Intestinal failure occurs when a person's intestines can't digest food and absorb the fluids, electrolytes and nutrients essential to life and normal development. Patients must then receive TPN, which provides liquid nutrition through a catheter or needle inserted into a vein in the arm, groin, neck or chest.

Total Parenteral Nutrition (TPN)

Patients with intestinal failure may receive all or most of their nutrients and calories intravenously through total parenteral nutrition, or TPN. TPN is given through a catheter placed in the arm, groin, neck or chest. Patients on TPN may live for many years, but long-term use of TPN can result in serious complications, such as bone disorders, central venous catheter infections and liver disease. If those complications become life-threatening, an intestinal transplant may be required.

Causes of Intestinal Failure

The most common cause of intestinal failure is short bowel syndrome where at least half or more of the small intestine has been removed.  Short bowel syndrome is typically a postsurgical condition for treatment of conditions such as trauma or necrotizing enterocolitis.

Pedatric vs. Adult Causes

Intestinal failure may also be caused by functional disorders such as Crohn's disease, a digestive disorder, or chronic idiopathic intestinal pseudo-obstruction syndrome. The conditions leading to intestinal failure are age-dependent. That is, some conditions are more closely associated with pediatric intestinal failure while others are more common with  intestinal failure in adults.

Pediatric Conditions Causing Intestinal Failure

  • Congenital malformations such as small bowel atresia, gastroschisis, aganglionosis
  • Infections of the gastrointestinal tract such as necrotizing enterocolitis)
  • Short bowel syndrome following extensive bowel surgeries secondary to mesenteric ischemia (e.g., midgut volvulus)
  • Absorptive impairment (e.g., intestinal pseudo-obstruction, microvillus inclusion disease)

Adult Conditions Causing Intestinal Failure

  • Short bowel syndrome following extensive surgeries secondary to mesenteric ischemia (following thrombosis, embolism, volvulus, or trauma)
  • Inflammatory bowel disease such as Crohn's disease
  • Small bowel tumors such as Gardner's syndrome (familial colorectal polyposis)
  • Tumors of the mesenteric root and retroperitoneum (desmoid tumor)