engleski

Short bowel syndrome

Short bowel syndrome (SBS) is a chronic intestinal failure due to massive resection of small intestine. Etiology is age dependent. In the neonatal period the most common causes are necrotising enterocolitis and surgical therapy of congenital malformations. Surgical resections due to volvulus or invagination are the leading causes later in childhood. To sustain life without parenteral nutrition, some 90-100 cm of small bowell is necesary, together with a part of colon. Resection of more than 75% of the bowel length will cause a full blown SBS, irrespective of the age of the patient. The extent of ileal resection is an important determinant of chronic intestinal failure in SBS together, with the presence of an ileocecal valve and the intact colon. Morphological and functional adaptation of the intestine result in clinical adaptation manifested as gradual increase in the tolerance of enteral nutrition, allowing reduction of parenteral intake while still maintaining age-appropriate growth and development of the patient. Clinically, patients with SBS present with 3 different phases: early phase, with acute diarrhoea and water and electrolyte loss ; second, intermediary phase, with malabsorption syndrome, and the third, late phase, characterized by a steady state, after maximal adaptation. Management of patients with SBS consists of a nutritional treatment, drug therapy and surgical procedures. Type of nutritional therapy depends on clinical presentation: correction of fluid and electrolyte imbalances and introduction of parenteral nutrition (early phase), increasing enteral intake while gradually diminishing parenteral nutrition (second phase) and individual adjustments of the diet to the residual absorptive capacities (late phase). Drug treatment depends on the symptoms and complications developed, with a special attention on promotion of small bowell adaptation. The aim of surgery in patients with SBS is to increase the intestinal length and surface and to slow the intestinal transit time.

short bowel syndrome; children; treatment

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