{
 "topic": "Short Bowel Syndrome",
 "slug": "short-bowel-syndrome",
 "category_id": 15019,
 "passage_count": 14,
 "source_chars": 10084,
 "enough_material": true,
 "references": [
  {
   "title": "Textbook of Pediatric Gastroenterology, Hepatology and Nutrition (Stefano Guandalini, Anil Dhawan)",
   "author": null,
   "pages": [
    581,
    625
   ]
  },
  {
   "title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition",
   "author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.",
   "pages": [
    672
   ]
  },
  {
   "title": "Pediatric Nutrition (Ronald E. Kleinman, Frank R. Greer)",
   "author": null,
   "pages": [
    823,
    1264,
    1265
   ]
  },
  {
   "title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
   "author": null,
   "pages": [
    2359,
    2392
   ]
  },
  {
   "title": "Signs and Symptoms in Pediatrics",
   "author": "Henry M. Adam,Jane Meschan Foy",
   "pages": [
    216
   ]
  },
  {
   "title": "Cover",
   "author": "Vitalsource Download",
   "pages": [
    995
   ]
  },
  {
   "title": "Pediatric Nutrition Handbook",
   "author": "Kleinman, Ronald E.",
   "pages": [
    697
   ]
  },
  {
   "title": "Zitelli and Davis' Atlas of Pediatric Physical Diagnosis: Expert Consult - Online",
   "author": null,
   "pages": [
    687
   ]
  }
 ],
 "passages": [
  {
   "source": "Textbook of Pediatric Gastroenterology, Hepatology and Nutrition (Stefano Guandalini, Anil Dhawan), p. 581",
   "text": "**43** ![](/tmp/pdf-images/pdf-0581-01.png) ## **Short Bowel Syndrome** Cecile Lambe and Olivier Goulet ## **Introduction** Short bowel syndrome is the leading cause of intestinal failure in adults and in children. By definition, SBS is due to intestinal malabsorption following the resection of a significant portion of the small intestine. Intestinal failure (IF) can be defined as a critical reduction of the gut mass or its function below the minimum needed to absorb nutrients and fluids required for adequate growth in children [1]. IF due to SBS may be reversible or irreversible, depending on a number of factors such as the underlying cause of SBS, the length of the remaining intestine, the preservation of the colon, the ileocecal valve, and the treatment used to develop or restore intestinal capacity. ## **Definition and Etiology**"
  },
  {
   "source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 672",
   "text": "## \u00bb **General Considerations** _Short bowel syndrome_ (SBS) is defined as a condition resulting from reduced intestinal absorptive surface that leads to alteration in intestinal function that compromises normal growth, fluid/electrolyte balance, or hydration status. The vast majority of pediatric patients with SBS have undergone neonatal surgical resection of intestine. The most common etiologies in children are necrotizing enterocolitis (45%); intestinal atresias (23%); gastroschisis **639** **GASTROINTESTINAL TRACT** (15%); volvulus (15%); and, less commonly, congenital short bowel, long-segment Hirschsprung disease, and ischemic bowel. In many instances, infants with SBS require PN in order to provide adequate caloric, fluid, and electrolyte delivery in the setting of insufficient intestinal absorptive function. The requirement of supplemental PN for more than 2\u20133 months in the setting of SBS or any other underlying disorder qualifies the diagnosis of intestinal failure (IF)."
  },
  {
   "source": "Pediatric Nutrition (Ronald E. Kleinman, Frank R. Greer), p. 1264",
   "text": "Chapter 45 ## Nutrition in Children With Short Bowel Syndrome ## **Background** Short bowel syndrome (SBS) is a complex disorder that is characterized as a malabsorptive state in the setting of a reduced length of small bowel. The complexity of this disorder stems from the nutritional, metabolic, and infectious complications that often occur as a consequence of altered anatomy and physiology. In pediatrics, SBS typically results from congenital anomalies, such as intestinal atresia, gastroschisis, midgut volvulus, and acquired causes, the most common of which is necrotizing enterocolitis (NEC; see Table 45.1). Although the actual incidence and prevalence of SBS in the United States are not precisely known, advances in neonatal intensive care and surgical techniques has likely increased the frequency with which pediatricians will encounter such patients."
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2392",
   "text": "## **Short Bowel Syndrome** Short bowel syndrome is the single most frequent etiology of intestinal failure in children (see Chapter 385.6). Many intestinal abnormalities such as stenosis, segmental atresia, gastroschisis, and malrotation may require surgical resection, but the most frequent primary cause of short bowel is _necrotizing enterocolitis_ . Rarely, a child can be born with congenital short bowel. In these conditions, the residual intestine may be insufficient to carry on its digestive- absorptive functions, resulting in severe chronic diarrhea, malnutrition, and failure to thrive, requiring long- term treatment with parenteral nutrition. ## **Nonspecific Diarrhea, Including Toddler\u2019s Diarrhea**"
  },
  {
   "source": "Pediatric Nutrition (Ronald E. Kleinman, Frank R. Greer), p. 1265",
   "text": "## **VI** ## Table 45.1. **Etiology of Short Bowel Syndrome in Infants and Children** Intestinal atresia Necrotizing enterocolitis Gastroschisis Midgut volvulus Total intestinal aganglionosis Congenital short bowel Ischemic injury Tumor Radiation enteritis Section VI: Nutrition in Acute and Chronic Illness **1251** **1252** Chapter 45 ## Table 45.2. ## **Factors Affecting Prognosis of SBS** Length of residual bowel Presence or absence of ileocecal valve Type of enteral feeds used Early introduction of enteral feeds Adaptive potential of residual bowel Frequency of infections Health of other organs (ie, stomach, pancreas, liver, colon) intestinal transplantation).[1] Encouragingly, more recent advances regarding treatment of catheter-related complications and PNALD plus the development of multidisciplinary programs specializing in the care of short bowel syndrome have improved survival to >90%.[2-5]"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2359",
   "text": "Short bowel (or short gut) syndrome is defined as a state of reduced functional intestinal mass that is lower than the required amount for the digestion and absorption of nutrients and fluids required for normal growth and survival. It results from congenital malformations or the resection of the small bowel (Table 385.6). Its incidence increases with low birthweight and earlier gestational age and is estimated at 7/1,000 live births in U.S. infants with birthweight <1,500 mg. Depending upon the area of the bowel resected or absent, loss of >50% of the small bowel, with or without a portion of the large intestine, can result in symptoms of generalized malabsorptive disorder or in specific nutrient deficiencies. At birth, the length of small bowel is 200- 250 cm; by adulthood, it grows to 300- 800 cm. Bowel resection is better tolerated in infants with an improved prognosis relative to adults due to the potential for intestinal growth and adaptation. An infant with as little as 15 cm of bowel with an"
  },
  {
   "source": "Signs and Symptoms in Pediatrics, p. 216",
   "text": "Short bowel syndrome is associated with congenital anomaly of the small intestine or follows extensive resection of the small intestine, resulting in chronic malabsorption and diarrhea.[65] It begins most commonly in the newborn period in association with necrotizing enterocolitis or a congenital anomaly such as gastroschisis, intestinal atresia, or malrotation with secondary midgut volvulus. Recovery may be prolonged, requiring the use of TPN for the fi rst several years of life.[66] Th e factors that appear to contribute to persistence of symptoms in neonates include the cause, decreased intestinal absorptive surface, altered intestinal motility, intraluminal bacterial overgrowth[67] (with secondary deconjugation of bile salts and hydroxylation of fatty acids), malabsorption of bile salts secondary to terminal ileal resection, and disaccharidase defi ciency. Among neonates, infants with necrotizing enterocolitis or gastroschisis tend to have a more prolonged course than those with other causes of short"
  },
  {
   "source": "Cover, p. 995",
   "text": "**Short-Bowel Syndrome** _Short-bowel syndrome_ is the leading cause of intestinal failure in infants, accounting for 44% of cases. It results from the surgical resection of so much affected bowel that there remains insufficient intestinal mass to maintain growth, hydration, or electrolyte balance. The risk of short-"
  },
  {
   "source": "Textbook of Pediatric Gastroenterology, Hepatology and Nutrition (Stefano Guandalini, Anil Dhawan), p. 625",
   "text": "## **Short Bowel Syndrome** SBS is the leading cause of intestinal failure in newborns as well as infants and young children, and it is most commonly the result of an extensive intestinal resection during the neonatal period. EN is often used in these circumstances, M. Puertolas and T. A. Sentongo 632"
  },
  {
   "source": "Pediatric Nutrition (Ronald E. Kleinman, Frank R. Greer), p. 823",
   "text": "**VI** Section VI: Nutrition in Acute and Chronic Illness **809** **810** Chapter 27 ## _Short-Bowel Syndrome (see also Chapter 45: Short Bowel Syndrome)_ Short-bowel syndrome (SBS) is the consequence of small bowel resection and the resulting severe nutrient malabsorption that occurs with loss of mucosal surface area. It is seen after surgical intervention for long-segment necrotizing enterocolitis, midgut volvulus, acute ischemic injury, smallbowel aganglionosis, gastroschisis, and diffuse Crohn disease of the small bowel. The best prognosis is for children in whom the ileum and ileocecal valve can be preserved.[43] In the initial postoperative period following loss of a significant length of small bowel, total parenteral nutrition is used. The early initiation of enteral feedings maximizes enteric hormonal stimulation and adaptation of the residual bowel by elongation, hypertrophy, and reduction in peristaltic rate."
  },
  {
   "source": "Pediatric Nutrition Handbook, p. 697",
   "text": "## _Short-Bowel Syndrome_ Short-bowel syndrome is the consequence of massive small-bowel resection and the resulting severe nutrient malabsorption that occurs with loss of mucosal surface area. It is seen after surgical intervention for long-segment necrotizing enterocolitis, midgut volvulus, acute ischemic injury, smallbowel aganglionosis, gastroschisis, and diffuse Crohn disease of the small bowel. The best prognosis is for children in whom the duodenum, distal ileum, and ileocecal valve can be preserved. **646** Chapter 27 PEDIATRIC NUTRITION HANDBOOK In the initial postoperative period after loss of a signifi cant length of small bowel, total parenteral nutrition is universally used. The early initiation of enteral feedings maximizes the enteric hormonal stimulation and adaptation of the residual bowel by elongation, hypertrophy, and reduction in peristaltic rate."
  },
  {
   "source": "Signs and Symptoms in Pediatrics, p. 216",
   "text": "or gastroschisis tend to have a more prolonged course than those with other causes of short bowel. In infants, symptoms of colitis may occur during the initiation of enteral feedings.[68] Later in life, volvulus, trauma, and Crohn disease are the most common causes of short bowel syndrome."
  },
  {
   "source": "Zitelli and Davis' Atlas of Pediatric Physical Diagnosis: Expert Consult - Online, p. 687",
   "text": "may rapidly manifest as abdominal wall edema, cellulitis, distention, and crepitus. Severe short bowel syndrome or death may occur from delayed recognition, diagnosis, and treatment of this important pediatric condition."
  },
  {
   "source": "Algorithms in Pediatrics, p. 380",
   "text": "Celiac disease, and intestinal lymphangiectasia are discussed in detail in next chapter. Box 3 shows brief clinical pointers and management of other pertinent causes of chronic diarrheas in children less than 3 years of age. **Box 3: Salient features and management of common causes of chronic diarrhea in children less than 3 years of age** - Short gut syndrome - { History of intestinal resection for small bowel obstruction or necrotizing enterocolitis in infancy - { Functional definition: massive small bowel resection >75% or dependence on parenteral nutrition for >6 weeks - { Symptoms occur when >150 cm small bowel + no colon or <70 cm small bowel + intact colon (older children/adults) - { Long-term total parenteral nutrition requirement ## **IMMUNODEFICIENCy STaTES**"
  }
 ]
}