Short bowel syndrome

Last reviewed: 22 Apr 2022
Last updated: 11 Mar 2020

Summary

Definition

History and exam

Key diagnostic factors

  • weight loss
  • diarrhea
  • volume depletion
  • peripheral or presacral edema
More key diagnostic factors

Other diagnostic factors

  • fatigue
  • fractures
  • 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
  • confusion
Other diagnostic factors

Risk factors

  • bowel resection
  • extensive abdominal radiation injury
  • gastroschisis
More risk factors

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
More 1st investigations to order

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
More investigations to consider

Treatment algorithm

ACUTE

jejunoileocolic anastomosis

jejunoileal anastomosis with fully resected colon

end jejunostomy or duodenostomy

ONGOING

all patients

Contributors

Authors

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

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

IL

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

Douglas Seidner, MD

Associate Professor of Medicine

Division of Gastroenterology, Hepatology and Nutrition

Director

Vanderbilt Center for Human Nutrition

Vanderbilt University Medical Center

Nashville

TN

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

UK

Disclosures

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

  • Differentials

    • Active Crohn disease
    • Celiac disease
    • Small bowel malignancy
    More Differentials
  • Guidelines

    • ESPEN guidelines on chronic intestinal failure in adults
    • ESPEN endorsed recommendations: definition and classification of intestinal failure in adults
    More Guidelines
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