Introduction: Short bowel syndrome (SBS) is the main cause for intestinal failure in children. Parenteral nutrition allows survival and growth while physiological intestinal adaptation occurs. Most patients can be weaned off PN after two to three years. In some cases, although adaptation was successful and PN was weaned without difficulty, intestinal symptoms such as abdominal pain, discomfort, abdominal distension and diarrhea occur, along with a decrease in growth rate requiring the resumption of PN - defining the overload gut syndrome (OGS). The aim of this study was to describe the natural history, the clinical and biological characteristics and the management of OGS. Methods: this retrospective study included all children referred to our center with a history of SBS weaned off PN who needed to return to PN between 2013 and 2018. All children were evaluated in our ward before resuming PN. Clinical history, examination and biological testings, including plasma citrulline levels were collected. A stool balance analysis was performed using the duplicate meal technique and bomb calorimetry. Results: Nine children were included in the study. Mean age at PN resumption was 10 years and 10 months. PN discontinuation lasted six and a half years (mean). All patients presented with stunting which was more important on height than on weight (loss of 1.5 SD and 1.3 SD respectively). All patients were hyperphagic, five of them received tube feeding on top of oral feeding, with mean ingested calories of 2336 kcalories/day, with a ratio of ingested calories over resting energy expenditure of 205%. Mean number of stools was 4.4 per day, with a mean stool weight of 1400g/day (52g/kg/d). One patient presented with recurrent episodes of D-lactic acidosis. Four patients had bicarbonates concentration under 21mmol/l. Mean total absorption rate was 69%. After PN start, the intestinal symptoms resolved, weight increased by 1.4 SD and height by 0.8 SD at 12 months follow-up. Biological parameters all improved. Mean citrulline plasma levels remained stable (26mmol/l at PN re-start - 24mmol/l at 12 months follow-up). Conclusion: Overload gut syndrome is a rare complication of SBS in children. It occurs in children with high enteral intake and low absorption rate: the remnant intestine cannot face the calorie load and becomes overwhelmed. Symptoms should be recognized early in order to resume PN in time to avoid consequences on final stature.