Short Bowel Syndrome

Abstract

Short bowel syndrome (SBS) is defi ned as malabsorption due to insuffi cient intestinal surface area, with an inability to sustain an adequate nutritional, electrolyte, or hydration status in the absence of specialized nutritional support. In adults, it is typically the consequence of extensive bowel resection, with loss of absorptive surface area. Over time, the intestine can adapt in order to ensure more effi cient absorption. Overall, the most important aspects of the management of patients with SBS are to provide adequate nutrition, and to provide suffi cient fl uid and electrolytes to prevent dehydration. Anastomosis of the residual small bowel to the colon is the most important surgical procedure, enhancing the ability of the colon to become an energy -absorptive organ, and allowing for decreased dependence on total parenteral nutrition (TPN). The prognosis for patients with SBS depends on the patient ' s age, the type and extent of bowel resection, along with the underlying disease and health of residual intestine.function is better described in terms of energy absorption and loss, rather than the length of residual intestine, and some patients with SBS will not have suffi cient loss of functional capacity so as to develop intestinal failure [1] . The patients at highest risk generally have a duodenostomy or a jejunoileal anastamosis with less than 35 cm of residual intestine, a jejunocolic or ileocolic anastamosis with less than 60 cm of residual intestine, or an end jejunostomy with less than 115 cm of residual intestine [2] .The incidence of SBS is diffi cult to assess given the lack of a national registry and prospective studies. However, based on multinational European data, the incidence and prevalence of severe SBS, necessitating long -term total parenteral nutrition (TPN), is estimated to be between 2 and 4 cases per 1 million persons per year [1] . These numbers, however, do not refl ect patients who do not require TPN, and approximately 50 -70% can successfully be weaned off TPN [3] . PathophysiologyThe major consequence of extensive bowel resection is loss of absorptive surface area, which results in malabsorption of nutrients, electrolytes, and water [4] . The degree of malabsorption is determined by the length and 262 Case A 57 -year -old man with atrial fi brillation develops severe abdominal pain. He is diagnosed with an acute abdomen. He undergoes an emergent exploratory laparotomy, where an embolism is found in the superior mesenteric artery, and 200 cm of gangrenous small bowel is resected, and an ileostomy is created. Two days later, the patient undergoes a second -look surgery, and a jejunocolic anastamosis is created. TPN is initiated postoperatively, and, once bowel function returns, enteral nutrition is initiated with a goal of gradually decreasing the requirement for TPN. Defi nition and EpidemiologyIntestinal failure is defi ned as an inability to sustain an adequate nutritional, electrolyte, or hydration status, in the absence of specialized nutritional support, and is often seen ...