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Crohn's Disease Forum » Treatment » Short Bowel Syndrome


01-09-2012, 05:28 AM   #1
DustyKat
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Short Bowel Syndrome

Definition:

Short bowel syndrome (SBS, also short gut syndrome or simply short gut) is a malabsorption disorder caused by the surgical removal of the small intestine, or rarely due to the complete dysfunction of a large segment of bowel.

Background:

The average length of the adult human small intestine is approximately 600 cm, as calculated from studies performed on cadavers. According to Lennard-Jones and to Weser, this figure ranges from 260-800 cm.[1] Any disease, traumatic injury, vascular accident, or other pathology that leaves less than 200 cm of viable small bowel or results in a loss of 50% or more of the small intestine places the patient at risk for developing short-bowel syndrome.

Short-bowel syndrome is a disorder clinically defined by malabsorption, diarrhea, steatorrhea, fluid and electrolyte disturbances, and malnutrition. The final common etiologic factor in all causes of short-bowel syndrome is the functional or anatomic loss of extensive segments of small intestine so that absorptive capacity is severely compromised. Although resection of the colon alone typically does not result in short-bowel syndrome, the condition's presence can be a critical factor in the management of patients who lose significant amounts of small intestine.[2, 3]

Massive small intestinal resection compromises digestive and absorptive processes. Adequate digestion and absorption cannot take place, and proper nutritional status cannot be maintained without supportive care. Today, the most common causes of short-bowel syndrome in adults include Crohn disease,[4] radiation enteritis, mesenteric vascular accidents, trauma, and recurrent intestinal obstruction. In the pediatric population, necrotizing enterocolitis, intestinal atresias, and intestinal volvulus are the most common etiologic factors. Other conditions associated with short-bowel syndrome include congenital short small bowel, gastroschisis, and meconium peritonitis.

Not all patients with loss of significant amounts of small intestine develop short-bowel syndrome. Important cofactors that help to determine whether the syndrome will develop or not include the premorbid length of small bowel, the segment of intestine that is lost, the age of the patient at the time of bowel loss, the remaining length of small bowel and colon, and the presence or absence of the ileocecal valve.

The above background information is taken from an article that covers:

-Overview-
Background
History of the Procedure
Problem
Epidemiology
Etiology
Pathophysiology
Presentation
Indications
Relevant Anatomy
Contraindications

-Workup-
Laboratory Studies
Imaging Studies
Other Tests
Diagnostic Procedures
Histologic Findings

-Treatment-
Medical Therapy
Surgical Therapy
Preoperative Details
Intraoperative Details
Postoperative Details
Follow-up
Complications
Outcome and Prognosis
Future and Controversies

Article:
http://emedicine.medscape.com/article/193391-overview

AGA Technical Review on Short Bowel Syndrome and Intestinal Transplantation - This is an older article but interesting nonetheless:
http://www.med.upenn.edu/gastro/docu...ewshortgut.pdf

Dusty.
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