short bowel syndrome

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short bowel syndrome

Short bowel syndrome is a condition after extensive resection of the small intestine, traditionally in Crohn’s disease or vascular pathology of the small intestine. Patients tolerate resections of up to 50% of the small intestine satisfactorily, with the remaining part functioning normally, and survival after more extensive resections is likely. The syndrome inevitably develops in patients with a remaining resection of the small intestine with a length of less than 100 cm.

Pathogenesis

    • Suction plane reduction
    • After resection of the proximal part of the small intestine, absorption of calcium, folic acid and iron is incredible, which can lead to hypocalcemia (tetany) and anemia
    • Removal of the ileum significantly impairs the absorption of bile acids and vitamin B2
    • Liver dysfunction, kidney stones (oxalates), and increased secretion of hydrochloric acid in the stomach are common complications of major bowel resection.
    • D-lactate (lactic acid) acidosis is an uncommon but life-threatening complication.

clinical picture. Malabsorption syndrome with diarrhea, steatorrhea and creatorrhea.

Treatment

    • Treatment begins with intravenous fluids, electrolytes, and parenteral nutrition.
    • The diet should include medium chain triglycerides, fat soluble vitamins and iron. It may be necessary to administer parenteral vitamin B12 and fixing agents (increasing the time of passage of food). Effective administration of cholestyramine, which binds non-absorbable bile salts and reduces the manifestations of diarrhea (the product reduces the pool of cholates, it is traditionally not used after resection of more than 100 cm of the distal ileum)
    • Total parenteral nutrition is extremely important in the postoperative period. In severe and non-correctable forms of the syndrome, long-term parenteral nutrition will be necessary.
    • Operative treatment. Resection of a small segment of the distal part of the small intestine and suturing it (turning 180°) into place in the form

anti-peristaltic segment, which allows you to increase the residence time of food in the intestine.

ICD

    • K91.2 Malabsorption following surgery, not elsewhere classified
    • 579.2 Short bowel syndrome