Chronic complications of the short bowel syndrome in children
- Jon A Vanderhoof, MD
Jon A Vanderhoof, MD
- Lecturer of Pediatrics, Harvard Medical School
- Professor Emeritus, University of Nebraska Medical Center
- Rosemary J Pauley-Hunter, NP-C, MS, RN
Rosemary J Pauley-Hunter, NP-C, MS, RN
- Pediatric Gastroenterology Nurse Practitioner
- Boys Town National Research Hospital, Omaha, NE
- Section Editors
- Craig Jensen, MD
Craig Jensen, MD
- Section Editor — Pediatric Gastroenterology
- Associate Professor
- Baylor College of Medicine
- Kathleen J Motil, MD, PhD
Kathleen J Motil, MD, PhD
- Section Editor — Pediatric Nutrition
- Professor of Pediatric Nutrition
- Baylor College of Medicine
Short bowel syndrome (SBS) is a malabsorptive state that typically occurs following extensive resection of the small intestine. It is a functional definition, implying a significant amount of malabsorption of both macronutrients and micronutrients and is not necessarily dependent on the loss of bowel or a particular length of bowel. SBS is the most common cause of intestinal failure, a term which refers to the state when an individual’s gastrointestinal function is inadequate to maintain his or her nutrient and hydration status without intravenous or enteral supplementation . SBS in children usually results from necrotizing enterocolitis, gastroschisis, and congenital intestinal anomalies . In addition to SBS, causes of intestinal failure in children include diseases or congenital defects that cause severe malabsorption, bowel obstruction, and dysmotility (eg, pseudo-obstruction).
Complications of SBS 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 at any time include watery diarrhea, electrolyte disturbances, and catheter-related complications [3,4]. Chronic complications include liver and biliary disease related to parenteral nutrition, bacterial overgrowth (sometimes associated with arthritis, colitis, or D-lactic acidosis), nutritional deficiencies, thromboses associated with central catheters, and enteric hyperoxaluria. Patients with intractable complications, or on rare occasions those with loss of adequate central venous access, may be candidates for small bowel transplantation .
The chronic complications of SBS in children are reviewed here. An overview of the management of SBS and its pathogenesis are reviewed separately. (See "Management of the short bowel syndrome in children" and "Pathophysiology of the short bowel syndrome".)
Watery diarrhea is the most common early complication of short bowel syndrome (SBS) in children, and may also be a chronic or recurrent problem. It is particularly likely to occur when enteral nutrition is advanced. Most often, it occurs when the osmotic load in the small intestine lumen exceeds the absorptive capacity. The volume load presented to the intestines also may be a contributing factor. Watery diarrhea also can be caused by malabsorbed bile salts in the colon (choleretic enteropathy, a secretory diarrhea), although this usually is not the primary cause.
Watery diarrhea often results in excessive fluid losses and electrolyte imbalance 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.
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- WATERY DIARRHEA
- CATHETER RELATED COMPLICATIONS
- Mechanical failure
- HEPATOBILIARY DISEASE
- Liver disease
- - Prevention
- ESOPHAGITIS/PEPTIC ULCER DISEASE
- ANASTOMOTIC ULCERS
- SMALL INTESTINE BACTERIAL OVERGROWTH
- D-lactic acidosis
- NUTRIENT DEFICIENCIES
- Common deficiencies
- Metabolic bone disease and rickets
- HYPEROXALURIA AND KIDNEY STONES
- SUMMARY AND RECOMMENDATIONS