Short Bowel Syndrome

This digestive condition is rare and prevents nutrients from being absorbed properly, as a result of a portion of the small intestine being removed. Short bowel syndrome can be used to describe any accident, injury or condition which leaves less than 50% of the small intestine or less than 200cm of the small bowel. Short bowel syndrome is sometimes known as small intestine insufficiency.

What causes short bowel syndrome?

The most common cause of the condition in adults is Crohn’s disease, but the condition can also be caused by a severe bowel infection, such as necrotising enterocolitis. Short bowel syndrome can be caused by a congenital defect (this means a defect which is present at birth) or it can develop in later life following surgery on the small intestines. Short bowel syndrome is most likely to affect individuals who have seen more than half of their small intestine surgically removed.

Symptoms of short bowel syndrome

Symptoms of short bowel syndrome include:

• Diarrhoea.
• Pale stools.
• Greasy stools with a foul odour.
• Loss of weight.
• Oedema (swelling) in the legs.
• Extreme tiredness.
• Cramping pains in the abdomen.
• Generally feeling unwell.
• Bloating.
• Malnourishment (this is caused by being unable to absorb nutrients from food).

Vitamin deficiency can cause the following symptoms:

• Night blindness (caused by a lack of vitamin A).
• Tetany (involuntary muscle contraction caused by a lack of calcium, magnesium and vitamins D and E).
• Bleeding and bruising easily (caused by a lack of vitamin K).
• Tingling and numbness.
• Lethargy (caused by a lack of vitamin B12, folic acid and iron).

Complications of short bowel syndrome

Possible complications of short bowel syndrome include:

• Increase in the growth of bacteria in the small intestine.
• Gallstones.
• Kidney stones.
• Metabolic acidosis (increased levels of acid in the blood, usually caused by diarrhoea).
• Weakened bones.
• Malnutrition and weight loss.

How is short bowel syndrome diagnosed?

A physical examination can enable doctors to detect several symptoms related to short bowel syndrome, including dry, flaky skin, muscle wasting, weight loss, oedema, restricted growth, paleness and limp hair and nails. Additional tests will be required to confirm a diagnosis, and they may include:

• Blood tests, including blood chemistry tests, liver function tests and full blood count.
• Electrolyte tests.
• Abdominal CT scan.
• Ultrasound.
• X-ray.
• Faecal fat test.

Treatment for short bowel syndrome

Most patients, especially young children and babies, are treated with high-nutrition feeds; known as Total Parenteral Nutrition or TPN. The diet provided for the patient is a high calorie diet, which aims to provide the patient with all the nutrients, vitamins and minerals they need. If a patient has specific vitamin deficiencies these will be addressed and, in some cases, vitamins may have to be injected. If the patient has anaemia this will be treated using iron, folic acid and vitamin B12 supplements.

Surgery may be carried out but is usually used as a last resort. Surgical procedures are usually classified as transplant or non-transplant. Non-transplant surgical procedures include connecting the rest of the small bowel to the colon, lengthening and tailoring the intestine (known as the Bianchi procedure) and tapering specific sections of the bowel. Transplant surgery is complex, carries risks and will usually only be recommended if all other treatments and therapies have failed. Transplant surgery also depends on the availability of healthy donor organs.

Surgery carries risk of infection and obstruction of the bowel, but the surgeon will weigh up the risks and benefits and advise you to make a decision based on this.

What is the outlook for patients with the condition?

The outlook depends on the individual case. A number of factors, including how much of the intestine has been removed and the general health of the individual, will affect the outlook. If short bowel syndrome was caused by surgery it is likely that the individual’s condition will improve slightly over time, which will improve the absorption of key minerals, vitamins and nutrients and reduce other symptoms.