CR01 SHORT GUT SYNDROME

Abstract

Introduction Short gut syndrome is a rare but devastating condition that can be associated with significant morbidity and mortality.Methods A literature search was performed using Medline, Embase, Ovid, and Cochrane database for studies between 1980 and 2005 using key words including intestinal failure and short gut syndrome. This was combined with clinical experience of patient management at tertiary colorectal surgical institutions in Australia (St Vincent’s, Melbourne), United Kingdom (St Mark’s, London), and the USA (Cleveland Clinic, Cleveland, Ohio).Results Short gut syndrome may occur secondary to reduction in actual or functional small bowel length, decreased absorptive capacity or functional ability. Three stages of intestinal failure can be recognised, hypersecretory (1–2 mths.), adaptive (3–12 mths.), and stabilisation (12–24 mths.) phases. There are significant pathophysiological changes to small bowel function during these stages affecting management of both fluid and electrolytes and nutrients, which must be proactively managed. Short gut syndrome often develops in the setting of a surgical catastrophe. Management can be summarised in terms of the 4 ‘R’s’, resuscitation, restitution, reconstruction, and rehabilitation. Patients should be managed in the context of a multidisciplinary team including gastroenterological, surgical, and nursing input. Home parenteral nutrition is essential for a proportion of the patients and small bowel transplantation may be a therapeutic option.Discussion Short gut syndrome is a complex management conundrum that has acute and chronic impact. A multidisciplinary team management, initially in a tertiary hospital environment, is essential.