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Effects of massive small bowel resection 

Effects of massive small bowel resection

Chapter:
Effects of massive small bowel resection
Author(s):

R.J. Playford

DOI:
10.1093/med/9780199204854.003.151007_update_001

February 27, 2014: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

Update:

Management—use of glucagon-like peptide 2 analogues to stimulate bowel adaptation; emphasis on importance of psychological support and attention to fluid/electrolyte balance; expanded notes on small bowel transplantation.

Updated on 30 May 2013. The previous version of this content can be found here.
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date: 25 April 2017

Major vascular events involving the superior mesenteric artery and Crohn’s disease are two of the main reasons for adults requiring massive intestinal resection. The ability of the residual bowel to adapt after resection varies greatly between patients, with factors influencing the ability to absorb nutrients being (1) the extent and site of resection, (2) the condition of the remaining intestine, (3) the presence of the ileocaecal valve, and (4) the function of other digestive organs.

Clinical problems are more likely to occur following large resections that include most of the ileum and include diarrhoea, fluid, and electrolyte imbalance, malnourishment (protein–energy malnutrition, mineral and vitamin deficiencies), gallstones, and renal stones.

In the initial postoperative period management requires assiduous fluid and electrolyte replacement, with many patients requiring parenteral nutritional supplements while the residual bowel adapts. Oral nutrition, initially consisting of elemental or polymeric diets administered by nasogastric or enteral tube feeding, should ideally be started within the first few days of surgery. Subsequently, small-volume, frequent, solid or semisolid meals with low fat and oxalate content should be introduced. Oral multivitamin and mineral supplements are needed; vitamin B12 injections are required following terminal ileum resection; regular long-term monitoring of fat-soluble vitamins (A, K, and D), vitamin B12, folate, magnesium, zinc, and bone status monitoring is required. Anti-peristaltic drugs are usually required. Growth factor administration, especially GLP-2 analogues, may stimulate bowel adaptation. Long-term intravenous nutrition is sometimes needed. Small bowel lengthening or transplantation is considered for some patients.

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