The problems of massive small bowel resection and difficulties encountered in management

Abstract

Summary Massive small bowel resection is imperative in the management of several pathological conditions and is accompanied by high operative mortality. In those that survive, serious nutritional disturbances are inevitable. Intestinal adaptation is said to occur but cannot be relied upon. Long-term parenteral nutrition is problematical and often unsuccessful. Many surgical procedures have been adopted in an effort to improve prognosis and have been found wanting. Controlled experimental studies in the use of reversed segments and a limited number of reported clinical cases using the method after massive resection suggest that this technique may improve the function of the residual intestine to such an extent that other supportive measures are unnecessary.

Effects of retrograde luminal perfusion of the canine jejunum on intestinal absorption and myoelectrical activity

“…In some cases, well-documented increases in intestinal absorption have been produced whilst in others no clear advantage was gained [7]. In clinical practice however, the behaviour of the reversed segment has been unpredictable.…”

“…In clinical practice however, the behaviour of the reversed segment has been unpredictable. In some cases, well-documented increases in intestinal absorption have been produced whilst in others no clear advantage was gained [7]. An improved understanding of the physiological response of the intestine to the retrograde flow of luminal contents might allow segmental reversal or similar procedures to be used with greater success in treating the short bowel syndrome.…”

Massive enterectomy: Indications and management

“…However, there do appear to be in the literature a small number of patients in whom the procedure has been performed successfully. In a review of 29 published cases, Barros D'Sa [36] found satisfactory to excellent results in 23 patients. In practical terms, the types of patient on whom one can use reversed loops are quite limi~ed.…”