Successful treatment with teduglutide in short bowel syndrome with intestinal failure secondary to small-bowel volvulus: a case report and literature review.

Introduction and importance: Short bowel syndrome (SBS) is a major cause of intestinal failure (IF). Patients with SBS-associated IF (SBS-IF) often require long-term parenteral nutrition (PN) and suffer from complications that impair quality of life (QoL), including severe diarrhea, weight loss, sleep disturbances, and catheter-related bloodstream infections (CRBSIs). Teduglutide, a glucagon-like peptide-2 analog, enhances intestinal adaptation and reduces dependence on PN. However, evidence in patients with ultra-short residual bowel remains limited, particularly in Japan. We report a case of severe SBS-IF in which teduglutide enabled complete weaning from PN and substantial QoL improvement. Case presentation and clinical discussion: A 70-year-old man underwent an emergency, extensive small-bowel resection for small-bowel volvulus, leaving approximately 20 cm of small intestine with the colon in continuity. He developed SBS-IF requiring home PN and experienced watery diarrhea (more than 10 times per day), weight loss, sleep disturbance, and recurrent CRBSI. Four years after surgery, teduglutide was initiated. Within 4 months, stool consistency improved, bowel frequency decreased to 3-5 times per day, and absorption improved, allowing complete discontinuation of PN. Body weight stabilized, CRBSI resolved, and disease-specific QoL improved markedly. Conclusion: Even in ultra-short-bowel SBS-IF, teduglutide may achieve PN independence and clinically meaningful improvements in gastrointestinal symptoms, weight maintenance, and QoL.