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Management of short bowel syndrome in children

Danielle A Stamm, RN, MSN, FNP-BC
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 malabsorptive state that is caused by massive resection of the small intestine, or occasionally by a congenital defect or disease-associated loss of absorption. It is a functional definition, implying a significant amount of malabsorption of both macronutrients and micronutrients, rather than a definition based upon 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 [1]. 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 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). (See "Overview of the causes of chronic diarrhea in children in resource-rich countries", section on 'Congenital secretory diarrheas'.)

The type and severity of clinical manifestations of SBS vary widely among patients, even among those with similar etiologies and with roughly similar anatomic features. Depending on the patient's age, underlying diagnosis, and the quantity and location of affected bowel, patients with SBS may have any combination of the following problems:

Excessive fluid and electrolyte losses

Inability to absorb adequate energy and macronutrients (protein, carbohydrates, and/or fats)

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Literature review current through: Nov 2017. | This topic last updated: May 24, 2017.
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