Our Summary

Short bowel syndrome (SBS) is a rare condition that occurs when a large portion of the small intestine is lost, usually due to surgery. It can also be caused by vascular diseases, inflammatory bowel disease, or tumors. This loss can lead to a range of problems, from the poor absorption of certain nutrients to complete intestinal failure, depending on how much and what part of the small intestine remains.

Over the past few years, the treatment of SBS has greatly improved, leading to better quality of life and survival rates. This is largely thanks to advancements in home-based nutrition that is administered through a vein (parenteral nutrition). Additionally, new treatment strategies have been developed over the last decade, including new drugs like teduglutide, which have shown promising results.

This paper reviews the current understanding of SBS, including its frequency, causes, and the progression of the disease. It also discusses the surgical options, such as procedures to lengthen the remaining intestine or transplant a new one, and medical management of the disease with a focus on recent advances. The paper also addresses complications that can arise from SBS, like infections, blood clots in the catheter, and liver disease associated with intestinal failure.

FAQs

  1. What is Short Bowel Syndrome (SBS) and what causes it?
  2. What are the recent advancements in the treatment of SBS?
  3. What are the possible complications that can arise from SBS?

Doctor’s Tip

One helpful tip a doctor might tell a patient about intestinal resection is to follow a strict diet plan tailored to their specific needs. This may include avoiding certain foods that are difficult to digest and focusing on high-calorie, nutrient-dense options to support optimal absorption. It is important for patients to work closely with a dietitian to ensure they are getting the necessary nutrients and vitamins to maintain their health. Additionally, staying hydrated and taking any prescribed medications as directed are crucial for managing symptoms and preventing complications. Regular follow-up appointments with healthcare providers are also important to monitor progress and make any necessary adjustments to the treatment plan.

Suitable For

Patients who may be recommended for intestinal resection include those with:

  1. Short bowel syndrome: Patients with a large portion of the small intestine lost due to surgery, vascular diseases, inflammatory bowel disease, or tumors may require intestinal resection to improve absorption of nutrients and manage complications.

  2. Intestinal obstruction: Patients with a blockage in the intestines that cannot be treated with other methods may require intestinal resection to remove the obstruction.

  3. Intestinal tumors: Patients with tumors in the intestines may require intestinal resection to remove the tumor and surrounding tissue.

  4. Crohn’s disease: Patients with severe Crohn’s disease that does not respond to medication may require intestinal resection to remove diseased portions of the intestine.

  5. Diverticulitis: Patients with severe diverticulitis that does not respond to other treatments may require intestinal resection to remove the affected portion of the intestine.

  6. Intestinal perforation: Patients with a hole or perforation in the intestine may require intestinal resection to repair the damage.

Overall, patients recommended for intestinal resection are those who have conditions that cannot be effectively managed with other treatments and who would benefit from surgical removal of a portion of the intestine.

Timeline

Before intestinal resection:

  1. Patient experiences symptoms of the underlying condition that leads to the need for intestinal resection, such as inflammatory bowel disease or tumors.
  2. Patient undergoes diagnostic tests, imaging studies, and consultations with healthcare providers to determine the extent of the intestinal damage and the need for surgery.
  3. Patient undergoes intestinal resection surgery to remove the diseased portion of the small intestine.
  4. Patient may require a temporary or permanent ileostomy or colostomy to divert waste from the surgical site.
  5. Patient is closely monitored in the hospital for complications and begins the recovery process.

After intestinal resection:

  1. Patient transitions to a specialized diet and may require parenteral nutrition to meet their nutritional needs.
  2. Patient undergoes regular follow-up appointments with healthcare providers to monitor their progress and adjust their treatment plan as needed.
  3. Patient may receive additional treatments, such as medications like teduglutide to improve intestinal function.
  4. Patient may undergo additional procedures, such as intestinal lengthening surgeries or intestinal transplants, if needed.
  5. Patient may experience complications related to SBS, such as infections, blood clots, or liver disease, and will require ongoing management of these issues.

Overall, the timeline for a patient before and after intestinal resection can vary depending on the individual case and the specific treatment plan. However, with advancements in medical management and surgical techniques, patients with SBS can experience improved quality of life and better outcomes.

What to Ask Your Doctor

Some questions a patient should ask their doctor about intestinal resection and short bowel syndrome include:

  1. What caused the need for intestinal resection in my case?
  2. What percentage of my small intestine was removed during the surgery?
  3. What are the potential complications or risks associated with short bowel syndrome?
  4. What symptoms should I watch out for that may indicate a problem with my remaining intestine?
  5. What dietary changes or restrictions should I follow to manage my condition?
  6. Will I need to take any medications to help with nutrient absorption or other issues related to SBS?
  7. Are there any surgical options available to help improve my quality of life or lengthen my remaining intestine?
  8. How often should I follow up with you to monitor my condition and address any concerns?
  9. Are there any clinical trials or new treatments available for short bowel syndrome that I should consider?
  10. How can I best manage any complications or side effects associated with my condition, such as infections or liver disease?

Reference

Authors: Massironi S, Cavalcoli F, Rausa E, Invernizzi P, Braga M, Vecchi M. Journal: Dig Liver Dis. 2020 Mar;52(3):253-261. doi: 10.1016/j.dld.2019.11.013. Epub 2019 Dec 28. PMID: 31892505