Short Bowel Syndrome

Abstract Short bowel syndrome (SBS) occurs when there is less than 200 cm of small intestine remaining. The minimal length of small intestine necessary to prevent lifelong dependence on parenteral nutrition (PN) is approximately 100 cm if the colon is absent and 60 cm with a completely functional colon present. Approximately 15% of all adults who undergo bowel resection exhibit sequelae of SBS, from either massive resection (76%) or multiple resections (24%). Irrespective of etiology, it is a disabling intestinal condition that reduces the quality and length of life and limits the social integration of the affected individual. The hallmark of SBS is severe nutrient and fluid malabsorption leading to chronic imbalances of micronutrient, fluid, protein, electrolyte, and carbohydrate stores. Quality of life is limited in these patients due to persistent manifestations of SBS via failure to thrive, diarrhea, dehydration, malnutrition, and long-term dependence on alternate means of nutritional support. Frequent medical care episodes for nutritional maintenance as well as acute management of associated complications interfere with social integration. Historically, SBS patients have been on long-term, if not lifelong, PN. However, in this chapter, the newer concepts of SBS management including intestinal rehabilitation, surgical optimization of absorption, and transplantation will be discussed. These discoveries are leading SBS patients to enteral autonomy and an improved quality of life.