Short bowel syndrome

Last reviewed: December 2018

Last updated: June 2018

Summary

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.

Definition

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. [1]

History and exam

Key diagnostic factors

weight loss
diarrhea
volume depletion
peripheral or presacral edema

Full details

Other diagnostic factors

fatigue
fractures
postprandial epigastric or RUQ 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
confusion

Full details

Risk factors

bowel resection
extensive abdominal radiation injury
gastroschisis

Full details

Diagnostic investigations

1st investigations to order

CBC
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)
INR

Full details

Investigations to consider

serum hepatic aminotransferases, alkaline phosphatase, and bilirubin (total and direct)
urine analysis
serum D-lactate
fecal fat quantification
upper GI contrast series
DXA scan
abdominal ultrasound
CT abdomen

Full details

Treatment algorithm

ACUTE

jejunoileocolic anastomosis

jejunoileal anastomosis with fully resected colon

end jejunostomy or duodenostomy

ONGOING

all patients

Contributors

Authors VIEW ALL 

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

Medical Director

Health Care Services Corporation

Chicago

Disclosures

AB is an author of references cited in this topic.

Acknowledgements

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.

Peer reviewers VIEW ALL 

Douglas Seidner, MD

Associate Professor of Medicine

Division of Gastroenterology, Hepatology and Nutrition

Director

Vanderbilt Center for Human Nutrition

Vanderbilt University Medical Center

Nashville

Disclosures

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

Hospital Dean

Intestinal Failure Unit

Hope Hospital

Salford

Manchester

Disclosures

Not disclosed. JS is the author of references cited in this monograph.

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Short bowel syndrome

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

jejunoileocolic anastomosis

jejunoileal anastomosis with fully resected colon

end jejunostomy or duodenostomy

all patients

Contributors

Authors VIEW ALL 

Alan Buchman, MD, MSPH, FACP, FACG, FACN, AGAF

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Douglas Seidner, MD

Disclosures

Jonathan Shaffer, MBBS

Disclosures

Differentials

Guidelines

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