Surgical Options in Short Bowel Syndrome

Abstract

Short bowel syndrome is characterized by a significant reduction in the effective intestinal surface by an anatomical or functional loss of the small intestine. It mainly occurs after extensive bowel resection, intestinal intrinsic disease or surgical bypass. The main complications are mal-digestion, malnutrition, dehydration and, potentially, lethal lesions. The management, based on appropriate and individualized nutritional support, is complexand requires a multidisciplinary approach including dietary, fluid and pharmacological management, co-morbid disease management and, sometimes, surgery. Numerous surgical procedures to relieve the consequences of massive intestinal resection have been devised, but many have not been employed in human clinics and have remained in the experimental surgery field. The choice of technique is dictated by the patient´s underlying pathophysiology and includes such factors as age, intestinal transit time, length of remnant bowel, presence of intact colon, degree of small bowel dilation, and others. Autologous intestinal reconstruction includes various techniques which manipulate the bowel surgically to facilitate the bowel adaptation process and restoration of enteral nutrition. The most accepted techniques are those elongating the bowel that may be applied only on dilated bowel. However, the intestinal transplantation can be a curative alternative for patients in whom intestinal rehabilitation attempts have failed and who are at risk of life-threatening parenteral nutrition complications.

Jejunal interposition for short bowel syndrome in a septuagenarian

“…This anti-peristaltic segment creates a partial mechanical obstruction thus prolong the transit time and enhance nutrient absorption [3]. The anti-peristaltic segment causes a reversed peristalsis hence disrupting the motility of the proximal intestine resulting in a delay of myoelectrical activity in the distal segment [4].…”

“…The suggested reversed segment lengths of 10–15 cm are recommended for adults and ~3 cm for children to provide maximum benefit of delaying the transit time [4]. Short segments may be inefficient in slowing transit time whereas longer segments may create bowel obstruction syndrome [4]. Hence, a careful balance of the interposed bowel segment would need to be achieved.…”

Establishing Short Bowel Syndrome in Nigerian Dogs

“…Intestinal resection is performed frequently in dogs and cats and is generally associated with minimal morbidity [1]. However, massive or extensive intestinal resection will result in short bowel syndrome [2][3][4][5][6][7][8][9]. Affected animals experienced insufficient intestinal absorptive capacity and this result in the clinical manifestations of diarrhea, dehydration, malnutrition and weight loss [1,10,11].…”