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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 its ability to absorb is severely compromised.

Few conditions in pediatric gastroenterology pose as great a challenge as short bowel syndrome (SBS). It represents a complex disorder that affects normal intestinal physiology with nutritional, metabolic, and infectious consequences.

Normal Physiology

The small intestine is completely formed by 20 weeks' gestation. Most of its growth prior to birth occurs in the third trimester. Before 27 weeks' gestation, the average length of the small intestine is 115 cm. This length increases to approximately 250 cm with a diameter of 1.5 cm after 35 weeks' gestation. In contrast, the adult intestine is 600 to 800 cm in length and 4 cm in diameter. The mucosal surface area increases with age. Infants have 950 square cm; adults have 7500 square cm.

The intestine has an enormous capacity to absorb secretions and ingested fluids. There is extra intestine normally which is why a major loss of the intestine may not result in SBS. Absorption occurs through the lining (mucosa) of the small intestine. Nutrients, vitamin B12, calcium, iron, and bile acids are absorbed through the cells of this lining. Mucus covers the surface of the mucosa cells and acts as a trap to hold nutrients in contact with the cell surface. Mucus also acts as a bacterial barrier.

What is Short Bowel Syndrome?

Short bowel syndrome, also refered to as SBS, or short gut syndrome, short bowel state or simply short gut is a disorder clinically defined by poor absorbtion of food, diarrhea and malnutrition. Simply this means where a significant amount of bowel (half or more of the small intestine) is lost, removed, or unable to function inside the body and medical intervention is required in order for the child to survive.

What causes short bowel syndrome?

The most common causes of short bowel syndrome in infants is as follows:

  • Necrotising enterocolitis (NEC) - an infection or inflammation (swelling) of the intestine of premature babies that can lead to the dying (necrosis) of the intestinal tract.
  • Gastroschisis - congenital (before birth) defect where a hole develops in the abdominal (stomach area) wall causing some of the bowel to escape through the hole and continue to develop on the outside of the baby's abdomen.
  • Malrotation - a congenital (before birth) abnormality of the bowel.
  • Volvulus - a complication of malrotation where the bowel twists and the blood supply to the bowel is cut off.
  • Intestinal atresia's - malformation where there is a narrowing or absence of a portion of the intestine
  • Bowel injury - from trauma

All these causes make digestion and absorbtion of food unable to take place and the body cannot obtain the essential nutriants to stay healthy without artificial drip feeding(see TPN and Nutrition). Not all patients who lose significant amounts of gut develop short-bowel syndrome.

  • Other factors that determine if a patient will be affected are:
  • The length of the bowel before any disease or complication started.