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Chronic complications of short bowel syndrome in children

Alexandra Carey, MD
Christopher Duggan, MD, MPH
Section Editors
Craig Jensen, MD
Kathleen J Motil, MD, PhD
Deputy Editor
Alison G Hoppin, MD


Short bowel syndrome (SBS) is a congenital or acquired malabsorptive state that usually is caused by extensive resection of the small intestine. The definition focuses on impairment of gastrointestinal function, implying a significant amount of malabsorption of both macronutrients and micronutrients, rather than focusing on the loss of a specific segment or length of bowel. The most common causes of SBS include necrotizing enterocolitis (NEC), congenital intestinal atresia (single or multiple), gastroschisis, volvulus (midgut or segmental), extensive Hirschsprung disease, and inflammatory bowel disease (IBD) [1]. (See "Management of short bowel syndrome in children".)

SBS due to surgical resection is the most common cause of intestinal failure, which is the state when an individual's gastrointestinal function is inadequate to maintain nutrient, growth, and hydration status without intravenous (IV) or enteral supplementation [2,3]. In addition to SBS, causes of intestinal failure in children include intestinal motility disorders (ie, chronic intestinal pseudo-obstruction) and intestinal epithelial defects (ie, congenital enterocyte disorders).

The majority of complications seen in patients with SBS are related to the site of resection, the process of intestinal adaptation, and the need for parenteral nutrition over the short or long-term. Acute and chronic complications of SBS are summarized in the table (table 1). Patients with irreversible or life-threatening complications, or with loss of adequate central venous access, may be candidates for small bowel or combined liver-small bowel transplantation [4].

Preventing complications should be a priority for all clinicians managing patients with SBS. These patients are complex and require coordination across many fields. A multidisciplinary team approach has been adopted in many centers across the world, consisting of a team made of gastroenterologists, surgeons, neonatologists, dieticians, nursing/nurse practitioners/physician assistants, pharmacists, speech/feeding therapists, social workers, and other ancillary health professionals. Such multidisciplinary intestinal rehabilitation programs are associated with reduced morbidity and mortality among pediatric patients with intestinal failure [5].

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 short bowel syndrome in children" and "Pathophysiology of short bowel syndrome".)

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Literature review current through: Nov 2017. | This topic last updated: Jun 07, 2017.
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