Health Encyclopedia

Short bowel syndrome

Definition

Short bowel syndrome is a problem that occurs when part of the small intestine is missing or has been removed during surgery. Nutrients are not properly absorbed into the body as a result.

Alternative Names

Small intestine insufficiency; Short gut syndrome; Necrotizing enterocolitis - short bowel

Causes

The small intestine absorbs much of the nutrients found in foods we eat. When two-thirds of the small intestine is missing, the body may not absorb enough food to stay healthy and maintain your weight.

Some infants are born missing part or much of their small intestine.

More often, short bowel syndrome occurs because much of the small intestine is removed during surgery. This type of surgery may be needed:

After gunshots or other trauma damaged the intestines
For someone with severe Crohn disease
For infants, often born too early, when part of their intestines dies
When blood flow to the small intestine is reduced due to blood clots or narrowed arteries

Symptoms

Symptoms may include:

Diarrhea
Fatigue
Pale, greasy stools
Swelling (edema), especially of the legs
Very foul-smelling stools
Weight loss
Dehydration

Exams and Tests

The following tests may be done:

Blood chemistry tests (such as albumin level)
Complete blood count (CBC)
Fecal fat test
Small intestine x-ray
Vitamin levels in the blood

Treatment

Treatment is aimed at relieving symptoms and ensuring the body receives enough hydration and nutrients.

A high-calorie diet that supplies:

Key vitamins and minerals, such as iron, folic acid, and vitamin B12
Enough carbohydrates, proteins, and fats

If needed, injections of some vitamins and minerals or special growth factors will be given.

Medicines to slow down the normal movement of the intestine can be tried. This may allow food to remain in the intestine longer. Medicines to lower the amount of stomach acid may also be needed.

If the body is not able to absorb enough nutrients, total parenteral nutrition (TPN) is tried. It will help you or your child get nutrition from a special formula through a vein in the body. Your health care provider will select the right amount of calories and TPN solution. Sometimes, you can also eat and drink while getting nutrition from TPN.

Small bowel transplantation is an option in some cases.

Outlook (Prognosis)

The condition may improve over time if it is due to surgery. Nutrient absorption may slowly get better.

Possible Complications

Complications may include:

Bacterial overgrowth in the small intestine
Nervous system problems caused by a lack of vitamin B12 (This problem can be treated with vitamin B12 injections.)
Too much acid in the blood (metabolic acidosis due to diarrhea)
Gallstones
Kidney stones
Dehydration
Malnutrition
Weakened bones (osteomalacia)
Weight loss

When to Contact a Medical Professional

Contact your provider if you develop symptoms of short bowel syndrome, especially after you have had bowel surgery.

References

Buchman AL. Short bowel syndrome. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 106.

Semrad CE. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 131.

Venick RS. Short bowel syndrome. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 6th ed. Philadelphia, PA: Elsevier; 2021:chap 35.

Review Date:5/4/2022
Reviewed By:Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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