IntroductionShort bowel syndrome is a condition that occurs when either the small intestine and/or the large intestine become physically shorter when a portion is removed by surgery, or functionally shorter, when a portion is damaged in a way that makes it nonfunctional.
- 15% of adult patients who undergo intestinal resection
- 3/4th cases resulting from massive intestinal resection
- 1/4th cases from multiple sequential resections.
- 1-year survival: 75%
- Jejunum‐colon: Jejunoileal resection and a jejunocolic anastomosis
- Jejunum‐ileum: Predominantly jejunal resection, and have more than 10 cm of terminal ileum and the colon remaining
- Uncommon cases and rarely have problems of undernutrition and therefore do not often need nutritional support
- Jejunostomy: Jejunoileal resection, colectomy, and formation of a stoma
|Crohn’s disease||Crohn’s disease|
|Mesenteric ischaemia||Ulcerative colitis|
|Small bowel volvulus||Mesenteric ischaemia|
Manifestations of SBS are due to:
- Loss of absorptive surface area
- Loss of site-specific transport processes
- Loss of site-specific endocrine cells and gastrointestinal (GI) hormones
- Loss of ileocecal valve
- Diarrhoea (life-threatening)
- Weight loss
- Malnutrition & malabsorption of macro- and micronutrients.
Nutritional management:Patient must achieve nutritional autonomy: independent of IV nutrition in the future. Enteral feeding of whole food should be encouraged to enhance intestinal adaptation even if TPN is required.
- Total parenteral nutrition (TPN): Often needed on prolonged/permanent basis to support SBS patient while intestinal adaptation takes place and specific treatment is instituted.
- Bowel lengthening procedures:
- Bianchi longitudinal intestinal lengthening and tailoring (LILT) procedure
- Serial transverse enteroplasty (STEP) procedure
- Transit slowing procedures (largely abandoned)