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Short Bowel Syndrome

Last updated Dec. 24, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Short Bowel Syndrome is a disorder of the gastrointestinal tract in which nutrients are malabsorbed, because a large part of the small intestine is either missing or has been surgically removed. The condition is rare, but may occur in both children and adults.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Short Gut
  • Short Gut Syndrome
  • Small Intestine Insufficiency

What is Short Bowel Syndrome? (Definition/Background Information)

  • Short Bowel Syndrome is a disorder of the gastrointestinal tract in which nutrients are malabsorbed, because a large part of the small intestine is either missing or has been surgically removed. The condition is rare, but may occur in both children and adults
  • Normally in adults, the average length of the small intestine is approximately 6 meters (19.7 feet). In individuals with a short bowel, the small intestine is reduced to less than 2 meters (6.6 feet) resulting in insufficient absorption of the nutrients
  • The adequate and proper absorption of water, minerals, and other nutrients is not possible in individuals having Short Bowel Syndrome
  • Some risk factors for Short Bowel Syndrome include pre-existing conditions, such as Crohn’s disease or intestinal atresia, treatment for cancer, or even a surgery involving the intestine
  • The main cause of Short Bowel Syndrome is removal of a part of the intestine in order to treat some health condition or disease. Such conditions may include Crohn’s disease, hernia, injury following accidents, loss of blood flow to a blocked blood vessel, or a cancer
  • Short Bowel Syndrome is characterized by diarrhea and it can lead to other symptoms such as dehydration, malnutrition, and weight loss
  • Some potential complications as a consequence of this condition includes an increase in the acidity of blood, weak bones, and the formation of stones in the gallbladder and kidneys
  • Short Bowel Syndrome is mainly treated by nutritional support and through replacement of the required nutrients. If Short Bowel Syndrome ensues as a result of surgery, the condition is not preventable
  • Individuals with Short Bowel Syndrome need lifelong monitoring to ensure proper care and nutrition. The prognosis with appropriate treatment and care is generally good

Who gets Short Bowel Syndrome? (Age and Sex Distribution)

  • Short Bowel Syndrome is considered a rare condition, with an occurrence frequency of 3 in a million
  • It occurs both in children (including infants) and in adults irrespective of male or female gender
  • The condition can affect individuals belonging to all races and ethnic groups

What are the Risk Factors for Short Bowel Syndrome? (Predisposing Factors)

The risk factors associated with Short Bowel Syndrome may include:

  • Crohn's disease, in which surgery of the intestine may be required
  • Necrotizing enterocolitis: Necrosis or tissue death of the bowel (in premature infants)
  • Intestinal injury following an accident
  • Surgical removal of the small intestine (50% or more) owing to conditions such as cancer or hernia

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Short Bowel Syndrome? (Etiology)

Removing some or most part of the intestine through surgery to treat diseases of the intestine is the principal cause of Short Bowel Syndrome.

  • Short Bowel Syndrome may occur in infants needing a surgery to treat conditions such as:
    • Necrotizing enterocolitis (an intestinal illness in babies)
    • Meconium ileus (blockage in the intestine due to thick fecal matter in babies, often seen in association with cystic fibrosis)
    • Omphalocele (a birth defect in which some internal organs protrude through the navel)
    • Gastroschisis (a defect when the intestine protrudes from the side of the umbilical cord)
    • Internal hernia
    • Jejunoileal atresia (incomplete formation of the intestine)
    • Midgut volvulus (a blockage in blood supply to mid-intestine)
  • Short Bowel Syndrome may also occur in children and in adults following surgery to treat conditions such as the following:
    • Intussusception (a section of the intestine folding into itself)
    • Crohn's disease
    • Bowel injury from accidents
    • Loss of blood flow due to a blocked blood vessel
    • Cancer

What are the Signs and Symptoms of Short Bowel Syndrome?

Some reported signs and symptoms associated with Short Bowel Syndrome include:

  • Diarrhea
  • Fatigue
  • Dehydration
  • Pale, greasy, or foul-smelling stools
  • Swelling (edema), especially of the legs
  • Weight loss
  • Easy bruising

How is Short Bowel Syndrome Diagnosed?

A diagnosis of Short Bowel Syndrome may include the following tests and exams:

  • Complete evaluation of medical history along with thorough physical examination
  • Checking albumin level in blood
  • Blood test for complete blood count (CBC)
  • Fecal fat test
  • Small intestine x-ray
  • Checking vitamin levels in blood

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Short Bowel Syndrome?

The possible complications of Short Bowel Syndrome may include:

  • Overgrowth of bacteria in the small intestine
  • Abnormalities related to nervous system, caused by a deficiency of vitamin B12
  • Increased acidity of blood (metabolic acidosis due to diarrhea)
  • Formation of stones in the gallbladder (gallstones) and kidney (kidney stones)
  • Malnutrition and weight loss
  • Weakened bones (osteomalacia)

How is Short Bowel Syndrome Treated?

The treatment of Short Bowel Syndrome is essentially aimed at managing the symptoms of the condition. The treatment steps may include:

  • A diet rich in calories that supplies essential vitamins and minerals, carbohydrates, proteins, and fats
  • Injection of vitamins and minerals, as needed
  • Treatment of anemia with vitamin B-12, folic acid, and increased iron in diet
  • Medications to slow down the normal intestinal movement (lengthening the time nutrients spend in the small intestine)
  • Parenteral (intravenous) nutrition, if enough nutrients are not delivered by normal feeding
  • Anti-diarrheal drugs to children, if advised by the healthcare provider
  • Antacids and anti-ulcer medications to prevent ulceration in the stomach (it is likely that the stomach will produce excess acid during the recovery period)
  • Antibiotics to combat bacterial infection, if any

How can Short Bowel Syndrome be Prevented?

There is no effective prevention of Short Bowel Syndrome, as it usually occurs as a result of surgical removal of a large part of the small intestine.

What is the Prognosis of Short Bowel Syndrome? (Outcomes/Resolutions)

  • For infants, the prognosis of Short Bowel Syndrome depends on the length of the intestine left in place; periodic follow-up would be needed for the rest of their lives
  • It is recommended that children be closely monitored to check for nutritional inadequacies and other conditions that may arise due to the continuous use of enteral or parenteral nutrition
  • Long-term use of total parenteral nutrition (TPN) can cause cholestasis; a medical condition wherein the flow of bile from the liver to the duodenum is blocked or obstructed
  • In general, the prognosis of Short Bowel Syndrome is good with suitable care and treatment

Additional and Relevant Useful Information for Short Bowel Syndrome:

Intestinal adaption is a physiological adaption of the remaining portion of the intestine to increase its absorptive ability. The changes may include:

  • Increase in surface area of absorption by enlarging and lengthening the villi
  • Diameter of the small intestine is increased
  • Movement of food through the small intestine is slowed

What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: April 26, 2016
Last updated: Dec. 24, 2018