Short bowel syndrome

• Alternative Names

  Small intestine insufficiency

• Causes, incidence, and risk factors

  When areas of the small intestine are removed by surgery, or they are not present due to a defect that occurred before birth (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 this condition 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
• 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 B12, 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)
• 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
  • Degeneration of the nervous system caused by a lack of vitamin B12 (combined systems disease)
  • Excess acid in the blood (metabolic acidosis)
  • Gallstones
  • Kidney stones
  • Malnutrition
  • Too much growth of bacteria
  • Weakened bones
  • 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.

• 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.

Review Date: 10/13/2008

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.