You perfom a full workup to evaluate her diarrhea. Lab results are below:
| Stool for C. Difficile | Negative for toxin gene or protein |
| GI Baterial PCR Panel | Negative |
| GI Viral PCR Panel | Negative |
| Stool OVa and Parasite | Negative x 3 |
| Stool giardia antigen | Negative |
| Fecal Elastase | Within Normal Limits |
| Celiac serologies | Negative |
A trial of a bile-acid binding resin did not change the nature of her stool frequency. Colonoscopy demonstrates normal ileocolonic anastomosis and distal ileum, which had both shown moderate inflammation prior to initiating Entyvio. You diagnose her with intestinal failure as a result of multiple bowel resections for Crohn’s Disease leading to short bowel syndrome (SBS).
Mini Discussion:
Short bowel syndrome (SBS) leading to intestinal failure (IF) is a highly morbid complication of Crohn’s disease (CD). In Crohn’s patients, typically short bowel is a result of surgical resection of small bowel or a loss of functional small bowel due to extensive inflammation, leading to a reduction in bowel length enough to cause malabsorption. Short bowel is defined as having < 200 cm of remaining of functional bowel. Intestinal failure is defined as the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that parenteral support (PS) is required to maintain health and/or growth.