Definition of Short bowel syndrome:

Short bowel syndrome is a condition in which nutrients are not properly absorbed (malabsorption) due to severe intestinal disease or the surgical removal of a large portion of the small intestine.

Causes, incidence, and risk factors:

When areas of the small intestine are removed by surgery, or they are missing due to a birth defect (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 short bowel syndrome 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
• Small intestine x-ray
• Vitamin levels in the blood

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 B-12, 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:

• Bacterial overgrowth in the small intestine
• Degeneration of the nervous system caused by a lack of vitamin B12 (combined systems disease)
• Excess acid in the blood (metabolic acidosis due to diarrhea)
• Gallstones
• Kidney stones
• Malnutrition
• Too much growth of bacteria
• Weakened bones (osteomalacia)
• 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.