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Short bowel syndrome

Definition

Short bowel syndrome is a condition in which nutrients are not properly absorbed (malabsorption) due to severe intestinal disease or the surgical removal of a large portion of the small intestine.

Alternative Names

Small intestine insufficiency

Causes, incidence, and risk factors

When areas of the small intestine are removed by surgery, or they are missing due to a birth defect (congenital defect), there may not be enough surface area left in the remaining bowel to absorb enough nutrients from food.

This condition is likely to develop when one-half or more of the bowel is removed during surgery. Risk factors include diseases of the small intestine that may require surgery, such as Crohn's disease. Necrotizing enterocolitis is a common cause of short bowel syndrome in infants.

Symptoms

• Diarrhea
• Fatigue
• Pale, greasy stools
• Swelling (edema), especially of the legs
• Very foul-smelling stools
• Weight loss

Signs and tests

• Blood chemistry tests (such as albumin level)
• Complete blood count (CBC)
• Fecal fat test
• Small intestine x-ray
• Vitamin levels in the blood

Treatment

Treatment is aimed at relieving symptoms, and may include:

• A high-calorie diet that supplies essential vitamins and minerals, as well as certain types of carbohydrates, proteins, and fats
• Some vitamins and minerals may need to be given by injection
• Treatment for anemia with vitamin B-12, folic acid, and increased dietary iron
• Medications to slow down the normal movement of the intestine (lengthens the time nutrients spend in the small intestine)
• Tube feeding through a vein (parenteral nutrition), if normal feeding is not delivering enough nutrients (patients can sometimes return to normal eating once they have stabilized)

Support Groups

Expectations (prognosis)

The condition may improve over time if it occurs as a result of surgery. There may be a gradual improvement in nutrient absorption.

Complications

• Bacterial overgrowth in the small intestine
• Degeneration of the nervous system caused by a lack of vitamin B12 (combined systems disease)
• Excess acid in the blood (metabolic acidosis due to diarrhea)
• Gallstones
• Kidney stones
• Malnutrition
• Too much growth of bacteria
• Weakened bones (osteomalacia)
• Weight loss

Calling your health care provider

Call for an appointment with your health care provider if you develop symptoms of short bowel syndrome, especially if you recently had bowel surgery.

Prevention

References

Semrad CE, Powell DW. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 143.