Short bowel syndrome typically presents as a consequence of extensive bowel resection.
The intestine may adapt over time to be more efficient at nutrient absorption; the extent of adaptation determines the extent of recovery.
Treatment and prognosis are dependent on the length, health, and anatomy of the remaining bowel.
Management includes electrolyte and fluid replacement, provision of adequate macronutrients, and prevention and treatment of micronutrient deficiencies during intestinal adaptation.
Primary anastomosis of residual small bowel to colon, when possible, is the most important surgical procedure to reduce the need for parenteral nutrition (PN).
Degree of oral medication absorption varies unpredictably between patients; alternative routes of administration should be sought where possible.
Physicians and patients need to watch closely for signs of dehydration, micronutrient deficiency, liver disease, and PN-related complications such as catheter infections and occlusions.
Typically, less than 200 cm of residual short bowel is present. This results in a loss of surface area for fluid, nutrient, and medication absorption, causing an inability to maintain protein-energy, fluid, electrolyte, or micronutrient balance when ingesting a conventionally accepted, normal diet.
History and exam
Key diagnostic factors
- weight loss
- volume depletion
- peripheral or presacral edema
Other diagnostic factors
- postprandial epigastric or right upper quadrant abdominal pain
- dysuria or renal colic
- abnormal neurologic examination
- jaundice and pruritus
- dermatologic signs
- night blindness
- motor weakness or altered gait
- proximal muscle weakness
- excessive bleeding
- bowel resection
- extensive abdominal radiation injury
1st investigations to order
- serum electrolytes
- BUN and creatinine
- serum albumin
- serum calcium, zinc, selenium, folate
- vitamins A, B1, B2, B6, B12, C, D, and E
- methylmalonic acid (MMA)
Investigations to consider
- serum hepatic aminotransferases, alkaline phosphatase, and bilirubin (total and direct)
- urine analysis
- serum D-lactate
- fecal fat quantification
- upper gastrointestinal contrast series
- Dual-energy x-ray absorptiometry (DXA) scan
- abdominal ultrasound
- CT abdomen
jejunoileal anastomosis with fully resected colon
end jejunostomy or duodenostomy
- Active Crohn disease
- Celiac disease
- Small bowel malignancy
- ESPEN guidelines on clinical nutrition in chronic intestinal failure
- ESPEN guidelines on home parenteral nutrition
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