Short Bowel Syndrome
Various medical conditions, such as Crohn’s disease, mesenteric ischemia, radiation enteritis, volvulus, and trauma, may cause damage to the intestinal tract. When the injury is severe, surgical removal of the diseased small bowel may be necessary.
Short Bowel Syndrome occurs when surgical management of these medical conditions requires repeated or extensive small bowel resection that leads to a markedly shortened small bowel length, particularly when there is 100 cm of small bowel with a portion of the colon present or 150 cm of small bowel where there is no colon remaining.
Short bowel syndrome is characterized by intractable diarrhea, weight loss, dehydration and malnutrition. Electrolyte abnormalities, vitamin and mineral deficiencies, kidney stones and gallstones may also occur. The etiology of these symptoms is twofold: Either the amount of bowel needed for absorption of nutrients and fluids is insufficient or the quality of the remaining bowel is very poor.
The extent to which the symptoms of short bowel syndrome manifest themselves depends on various factors:
- The disease that caused the damaged bowel as well as the amount of disease activity remaining in the preserved bowel.
- The amount and location of the intestine that was removed.
- The likelihood that the remnant is able to assume functions of the bowel that have been removed (a process known as intestinal adaptation).
- Whether the ileocecal valve (a valve between the small intestine to the colon or large intestine) is removed.
Patients who require or who may be headed toward parenteral nutrition to manage their short bowel syndrome may benefit from the expertise offered by members of the Digestive Disease Center through either the Home Parenteral Nutrition Program or the Intestinal Rehabilitation Program.
These integrated services make certain that dietary and medical therapy is optimized so that the absorptive function of the remaining bowel is used to its maximal extent. This permits some patients to minimize reliance on parenteral nutrition and in some cases discontinue this therapy.
When parenteral nutrition is required on a permanent basis, these programs can make certain that all nutrient requirements are met with this therapy.