Metabolic effects of small bowel reversal in treatment of the short bowel syndrome.

Abstract

MASSIVE bowel resection remains a clinical catastrophe. 1 While patients who survive removal of 50% of the small bowel can live relatively normal lives, serious problems occur when less than 8 feet of bowel remains. Severe diarrhea, dehydration, hypovolemia, acidosis, electrolyte imbalance, renal failure, steatorrhea, hypoproteinemia, weight loss, and cachexia characterize the gastrointestinal insufficiency of the short-bowel syndrome. Small-bowel reversal is a method of increasing intestinal absorption after massive bowel resection. 2-4 The short antiperistaltic segment, anastomosed terminally to the remaining small bowel, maintains its functional polarity and acts as an incomplete small-bowel obstruction. 5 Gastrointestinal transit is delayed, and contact time between nutrients and intestinal mucosa is increased, allowing more effective absorption of foodstuffs from the bowel lumen. Hammer et al, 2 utilizing these facts, evaluated reversed segments in dogs after 80% bowel resection. Control animals with comparable amounts of gastrointestinal absorptive surface died from dehydration, electrolyte imbalance,