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Short Bowel Syndrome

What is short bowel syndrome?

Short bowel syndrome occurs when part of the small bowel is missing or dysfunctional. This may lead to lack of adequate nutrients being absorbed. Some infants are born missing part of their intestines, but the majority of the time it is related to surgical removal. There are numerous reasons why small intestine may need to be resected:

  • Some infants are born with anatomic abnormalities of the GI tract.
  • Some infants, typically those born premature, develop extensive injury to their intestines and require both antibiotics and surgical resection of nonviable bowel.
  • Significant abdominal trauma damaging the intestines may require surgery.
  • Children who have severe Crohn's disease in the small bowel may need surgery.

What are symptoms of short bowel syndrome?

Children with short bowel syndrome often have:

  • Diarrhea and/or foul smelling stools
  • Poor weight gain or weight loss
  • Gas and bloating
  • Poor appetite
  • Fatigue
  • Vomiting

What are complications of short bowel syndrome?

Children with short bowel syndrome are prone to:

  • Malnutrition
  • Dehydration from stool loss, with or without electrolyte or mineral deficiencies
  • Vitamin deficiency due to poor absorption
  • Small intestinal bacterial overgrowth
  • Liver disease from long term parenteral (IV) nutrition
  • Difficulty with oral feeding
  • Obstruction in the intestine from previous surgery
  • Kidney stones
  • Gallstones

What is the treatment of short bowel syndrome?

Children with short bowel syndrome need significant adjustments to their nutrition according to the intestinal ability to digest and absorb nutrients. Intravenous nutrition, or Total Parenteral Nutrition (TPN) may be required to maintain nutrition and hydration as the small intestine that is remaining tries to adapt over time.

Sometimes specific formulas that are pre-digested or hypoallergenic can be used to improve absorption. A feeding tube can be helpful in providing nutrients and promoting intestinal adaptation, but children can eat by mouth as well, which can help with preventing oral aversion to foods.

Intestinal transplant and/or liver transplant can be considered for severe forms of intestinal failure or inability of the available intestine to adapt.

University of Rochester Medical Center, Department of Pediatrics, Gastroenterology, Hepatology and Nutrition Division