Typically presents as a complication of extensive bowel resection.
The intestine adapts 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 location of 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).
There should be an awareness of the possibility for medication malabsorption.
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.
Short bowel syndrome (SBS) refers to a condition wherein substantial portions of the small intestine are absent, either congenitally or due to resection. 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
Alan Buchman, MD, MSPH, FACP, FACG, FACN, AGAF
Visiting Professor of Clinical Surgery and Medical Director of the Intestinal Transplant and Rehabilitation Center
University of Illinois at Chicago
Health Care Services Corporation
AB is an author of references cited in this topic.
Dr Alan Buchman would like to gratefully acknowledge Dr Michael Roth, a previous contributor to this topic. MR is an author of a reference cited in this topic.
Douglas Seidner, MD
Associate Professor of Medicine
Division of Gastroenterology, Hepatology and Nutrition
Vanderbilt Center for Human Nutrition
Vanderbilt University Medical Center
DS has been an advisor for B. Braun and Baxter Healthcare; has received lecture fees from Coram Healthcare, EMD Serono, and Nutrishare; has prepared a newsletter for Mayne Pharma; and has received research funding from Baxter Healthcare and NPS Pharmaceutical.
Jonathan Shaffer, MBBS
Intestinal Failure Unit
Not disclosed. JS is the author of references cited in this topic.
- Active Crohn disease
- Celiac disease
- Small bowel malignancy
- ESPEN guidelines on chronic intestinal failure in adults
- ESPEN endorsed recommendations: definition and classification of intestinal failure in adults
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