Short bowel syndrome is a malabsorptive state that may follow massive resection of the small intestine. Short bowel syndrome in children usually results from necrotizing enterocolitis and congenital intestinal anomalies. Complications of short bowel syndrome are related to the site of resection, the process of ileal adaptation, and the need for parenteral nutrition over the short or long-term. Acute complications that can occur anytime include watery diarrhea, electrolyte disturbances, and catheter-related complications [1,2]. More chronic complications include liver and biliary disease associated with parenteral nutrition, bacterial overgrowth-induced arthritis, colitis, and D-lactic acidosis, nutritional deficiencies, and enteric hyperoxaluria. Patients with intractable complications may be candidates for small bowel transplantation .
The chronic complications of short bowel syndrome in children are reviewed here. An overview of the management of short bowel syndrome and its pathogenesis are reviewed separately. (See "Management of the short bowel syndrome in children" and "Pathophysiology of the short bowel syndrome".)
This topic is also discussed in a position statement and technical review, issued by the American Gastroenterological Association (AGA). The AGA position statement for short bowel syndrome and intestinal transplantation , as well as other AGA guidelines, can be accessed through the AGA web site at www.gastro.org/practice/medical-position-statements.
Watery diarrhea is the most common early complication of short bowel syndrome in children. It may occur any time, but particularly when enteral nutrition is advanced. Most often, it occurs when the osmotic fluid load in the small intestine exceeds the absorptive capacity.
Fluid losses and electrolyte imbalance are common in patients who have undergone massive intestinal resection. Frequent monitoring of serum and stool electrolytes is critical to providing adequate replacement fluids. Situations that may exacerbate hypovolemia (eg, excessive heat exposure) should be avoided.