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By Amnah Azim
Learning Objectives To know what is Short bowel syndrome
To know about changes in small bowel after resection
Learn how to manage with different medical n surgical strategies.
Short Bowel Syndrome Short bowel syndrome is a spectrum of
pathophysiological disorder that occurs as a consequences of insufficient absorptive and digestive small intestinal mucosal surface area. [1]
OR Parental nutrition dependence for greater than
3 months.[2]
Ref : 1. Warner BW ,Small bowel syndrome, text book of pediatric surgery 6th edition 2 Jaksic T , ,Small bowel syndrome, text book of pediatric surgery 7th edition
EtiologySmall Gut Length
Mid gut volvulus
Intestinal atresia
NEC
Gastroschiasis
Functional Disorders
Aganglionosis
Idiopathic intestinal obstruction
Crohn’s disease
Gut Resection Rickham (1967) – an extensive resection to maximum of
75cm
Kuffer (1972) – 15cm with ileocaecal valve
- 38cm without ileocaecal valve
Dorney (1985) – 11cm with I/C valve or 25cm without I/C valve
what happens when gut resected?
Acute phase : starts immediately and upto 3-4 months
Adaptation phase : starts immediately and last upto 12-24 months
Maintenance phase : absorptive capacity will be maximize.
How does the bowel adapt? Cellular hypertrophy and
hyperplasia
Villi become taller
Crypts become deeper
Intestinal dilatation
Altered motility
Hormonal changes
Medical management Fluid and electrolyte balance:
Fluid loss in ostomy, diarrhea + Normal fluid requirement +300~500ml for insensible loss
Enteral feeding can be initiated at 5-1o post op day if not surical complication occur.
Breast milk feeding is appropriate in infants due to abundance in epidermal growth factor
Lactose intolerance is not uncommon; glucose polymer is better.
Initiat TPN in high output ostomies and if not tolerating enteral feed .
Fluid Management
Parrish. Pract Gastroenterol. 2005
Or 800ml urine with sodium 20mmol/L
Pharmacologic Agents
High-dose loperamide
Codeine phosphate
H2 blocker (i.e. ranitidine)
Proton pump inhibitor (i.e. omeprazole)
Somatostatin analogue (octreotide)
Cholestyramine
Cholecystokinin
Antibiotics
Surgical therapies Procedures that
Delay intestinal transit time
Construction of various valves and sphincters
Construction of anti-peristaltic (reversed) segments
Recirculating loops
Colonic interposition
Increase absorptive area
Intestinal tapering and lengthening
Small bowel transplantation
Isolated small intestinal graft
Combined liver/small intestinal grafts
Townsend et al. Sabiston Textbook of Surgery 17th Edition. 2004
Tapering
Bowel lengthening Cutting bowel longitudinally, preserve blood supply to
both sides and create a segment of bowel twice length, half diameter without loss of mucosal surface area.
Bowel lengthening
Antiperistaltic small intestine segment
Colonic interposition
Any Query??
Thank you
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