Short bowel syndrome

Causes

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

Exams 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)

Outlook (Prognosis)

The condition may improve over time if it occurs as a result of surgery. There may be a gradual improvement in nutrient absorption.

Possible Complications

• Bacterial overgrowth in the small intestine
• Nervous system problems caused by a lack of vitamin B12
• Too much acid in the blood (metabolic acidosis due to diarrhea)
• Gallstones
• Kidney stones
• Malnutrition
• Weakened bones (osteomalacia)
• Weight loss

When to Contact a Medical Professional

Call for an appointment with your health care provider if you develop symptoms of short bowel syndrome, especially if you recently had bowel surgery.

Alternative Names

Small intestine insufficiency

References

Semrad CE. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 142.

Update Date: 5/1/2012

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.