its an overview about short bowel syndrome

1. By Amnah Azim

2. Learning Objectives
 To know what is Short bowel syndrome
 To know about changes in small bowel after resection
 Learn how to manage with different medical n surgical
strategies.

3. Short Bowel Syndrome
 Short bowel syndrome is a spectrum of
pathophysiological disorder that occurs as a
consequences of insufficient absorptive and digestive
small intestinal mucosal surface area. [1]
OR
 Parental nutrition dependence for greater than
3 months.[2]
Ref : 1. Warner BW ,Small bowel syndrome, text book of pediatric surgery 6th edition
2 Jaksic T , ,Small bowel syndrome, text book of pediatric surgery 7th edition

4. Etiology
Small Gut Length
 Mid gut volvulus
 Intestinal atresia
 NEC
 Gastroschiasis
Functional Disorders
 Aganglionosis
 Idiopathic intestinal
obstruction
 Crohn’s disease

5. Gut Resection
 Rickham (1967) – an extensive resection to maximum of
75cm
 Kuffer (1972) – 15cm with ileocaecal valve
- 38cm without ileocaecal valve
 Dorney (1985) – 11cm with I/C valve or
25cm without I/C valve

6. what happens when gut resected?
 Acute phase : starts immediately and upto 3-4 months
 Adaptation phase : starts immediately and last upto 12-
24 months
 Maintenance phase : absorptive capacity will be
maximize.

9. How does the bowel adapt?
 Cellular hypertrophy and
hyperplasia
 Villi become taller
 Crypts become deeper
 Intestinal dilatation
 Altered motility
 Hormonal changes

10. Medical management
 Fluid and electrolyte balance:
Fluid loss in ostomy, diarrhea + Normal fluid requirement
+300~500ml for insensible loss
 Enteral feeding can be initiated at 5-1o post op day if not
surical complication occur.
 Breast milk feeding is appropriate in infants due to
abundance in epidermal growth factor
 Lactose intolerance is not uncommon; glucose polymer is
better.
 Initiat TPN in high output ostomies and if not tolerating
enteral feed .

11. Fluid Management
Parrish. Pract Gastroenterol. 2005
Or 800ml urine with sodium 20mmol/L

12. Pharmacologic Agents
 High-dose loperamide
 Codeine phosphate
 H2 blocker (i.e. ranitidine)
 Proton pump inhibitor (i.e. omeprazole)
 Somatostatin analogue (octreotide)
 Cholestyramine
 Cholecystokinin
 Antibiotics

13. Surgical therapies
 Procedures that
 Delay intestinal transit time
 Construction of various valves and sphincters
 Construction of anti-peristaltic (reversed) segments
 Recirculating loops
 Colonic interposition
 Increase absorptive area
 Intestinal tapering and lengthening
 Small bowel transplantation
 Isolated small intestinal graft
 Combined liver/small intestinal grafts
Townsend et al. Sabiston Textbook of Surgery 17th Edition. 2004

14. Tapering

15. Bowel lengthening
 Cutting bowel longitudinally, preserve blood supply to
both sides and create a segment of bowel twice length,
half diameter without loss of mucosal surface area.

16. Bowel lengthening

17. Antiperistaltic small intestine segment

18. Colonic interposition

19. Any Query??

20. Thank you