Surgical Reflection Short Bowel Syndrome Truly Challenging
DOI:
https://doi.org/10.14738/bjhmr.115.17810Abstract
This article discusses short bowel syndrome from a surgical perspective. It notes that the short intestine is difficult to define precisely because measuring the remaining bowel is subjective, and presents definitions based on the length of small intestine left after resection, including the distinction between anatomical and physiological short bowel syndrome. The syndrome is described as a rare condition resulting from reduced intestinal length or functional capacity, with significant morbidity and mortality and with physical, psychosocial and economic burdens, as many patients require long-term home parenteral nutrition. The authors review the anatomy and physiology of the small and large intestine, including where nutrients, vitamin B12, bile salts, magnesium, water and sodium are absorbed, and the influence of diet on gut homeostasis. They then examine how small bowel length is measured, comparing intraoperative estimation by the surgeon, the current gold standard but notoriously unreliable, with barium transit studies, three-dimensional computed tomography and magnetic resonance enterography. The article also draws on literature on teduglutide, modulation of the gut microbiota and surgical options such as intestinal lengthening, serial transverse enteroplasty, reversed intestinal segments and intestinal valves, and stresses that minimising bowel resection at the initial operation and restoring intestinal continuity can help avoid short bowel syndrome.
Abstract prepared by the editorial office from the full text of the article; the authors did not supply one.
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Copyright (c) 2024 Dianna Estefany Lopez Amaro, Mauricio Israel Flores Pazos, Gema Méndez Barrón, Carol Atzimba Zepeda Carrillo, Angel Flores Montiel, Carlos Iván Díaz Terrones, Laura Valeria Medina Román, Jaime Ricardo López Sixtos, Jesús Ricardo Delgado Gómez, Iñaki Rubén Montes de Oca Ambriz, Morelos Adolfo García Sánchez
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