Short bowel syndrome
In pediatrics, the most common cause of short bowel syndrome is necrotizing enterocolitis with small bowel resection. Intestinal atresia, gastroschisis, malrotation with volvulus, and Hirschsprung disease with proximal resection are other common causes of short bowel syndrome in children.
In adults, Crohn disease with small bowel resection, malignancy, volvulus, and vascular compromise with bowel infarction are the most common etiologies.
Symptoms depend on the phase of illness and can vary based on the length and location of resected bowel. Acute-phase symptoms include large volume gastrointestinal fluid losses and metabolic disarray; they begin immediately following surgical resection and can last for approximately 1 month. Over time, the bowel adapts to increase nutrient absorption. This may last for 1-2 years.
Most symptoms are attributed to malabsorption (weight loss, diarrhea, abdominal discomfort, steatorrhea, dehydration, cholelithiasis) and malnutrition due to mineral and vitamin deficiencies (eg, zinc, magnesium, calcium, iron, folic acid, fat-soluble vitamins). These symptoms can include fatigue, scaling rash, muscle spasms, and impaired clotting.
K91.2 – Postsurgical malabsorption, not elsewhere classified
26629001 – Short bowel syndrome
Differential Diagnosis & Pitfalls
- Hirschsprung disease with small bowel extension
- Midgut volvulus (see intestinal malrotation)
- Mesenteric ischemia (acute, chronic)
- Pancreatic insufficiency (eg, due to chronic pancreatitis)
- Celiac disease
- Protein-losing enteropathy
- Intestinal bacterial overgrowth
- Bile acid diarrhea
- Inflammatory bowel disease (eg, Crohn disease, ulcerative colitis)
- Malnutrition due to poor intake (anorexia nervosa)
- Pernicious anemia
- Small bowel tumor