Definition of Short Bowel Syndrome
Short Bowel Syndrome (SBS) is defined as malabsorption resulting from anatomical or functional loss of a significant length of the small intestine. Most commonly this occurs after bowel resection in the newborn period (i.e., secondary to necrotizing enterocolitis). The amount of bowel that must be lost to produce malabsorption is variable and depends on which section(s) is/are lost, and whether the ileocecal valve is preserved.
Nutritional Support in SBS
Immediately after bowel surgery that results in SBS, total parenteral nutrition (TPN) is required until bowel function returns (bowel sounds are detected, and stool is produced). Depending on the severity of short bowel syndrome, full enteral/oral nutrition may be achieved in a matter of weeks to months, or may never be achieved.
During the physical examination, pay close attention to these clinical signs.
- State of hydration
- State of nutrition, as measured by a patient's weight for height and anthropometric measurements
- Signs of sepsis
- Form of nutritional therapy used in the patient (eg, central line access or enteral access)
- Specific clinical signs of nutritional deficiency
- Signs of liver disease
- Necrotizing enterocolitis, intestinal atresias, and midgut volvulus are the most common causes of short bowel syndrome in the neonatal period.
- Intussusception with ischemic small-intestinal injury is a common cause of short bowel syndrome in older infants and children.
- Through innovations in the surgical management of patients with chronic inflammatory bowel disease, Crohn disease is a less frequently associated cause of short bowel syndrome.
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