Resected bowel syndrome: clinical course and treatment options

The current concepts of the short bowel syndrome and malabsorption after intestinal surgery are generally accepted, but do not fully reflect the patients condition, making it difficult to diagnose and treat it. Aim.The purpose of the study is to analyze the clinical course of the patients after bowel resection, to create a classification based on the variants identified to allow for a differentiated treatment and to introduce the concept of the resected bowel syndrome. Materials and methods.We observed 239 patients (96 men and 143 women) aged 18 to 80 who underwent intestinal resection for 1 month to 16 years (from 2002 to 2018). The 1st group included 96 patients with small bowel resection (40 men and 56 women). The 2nd group included 39 men and 58 women with small bowel resection, including the resection of the ileocecal valve and the right-hand side of the colon (n=97). The 3rd group included 17 men and 29 women with the resection of the right-hand side of the colon or colectomy (n=46). The survey included the NRS-2002 (Nutritional Risk Screening 2002) screening test to identify nutritional risk, a clinical assessment of the symptoms that occurred after the surgery, instrumental methods (esophagogastroduodenoscopy, colonoscopy with biopsy, ultrasound of the abdominal cavity organs and the kidneys, a plain radiography of the abdominal cavity organs, an X-ray examination of the small intestine and the intestinal passage), serum citrulline and short-chain fatty acids in faeces. Results.Based on the analysis of the clinical symptoms and the nutritional status of the patients, a new concept is proposed the resected bowel syndrome with two variants of its progression: either with or without the development of nutritional insufficiency of three types: the dehydration type, the protein-energy insufficiency type and a mixed type. Type 1 requires the use of antimicrobials with the control of SCFA concentrations in faeces. Type 2 requires the introduction of an optimal amount of easily digestible protein to correct protein-energy deficit. The 3rd (most severe) mixed type requires prescription of a parenteral nutrition component with the control of citrulline concentration in the blood serum. Conclusion.The proposed concept the resected bowel syndrome makes it possible to improve its diagnosis, take into account the variants of its progression and allow for a differentiated treatment.

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Intestinal Obstruction due to Bilateral Strangulated Femoral Hernias

Case Reports in Surgery ◽

10.1155/2014/195736 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

Ioannis Nikolopoulos ◽

Eshan Oderuth ◽

Eleni Ntakomyti ◽

Bengt Kald

Keyword(s):

Small Bowel ◽

Bowel Resection ◽

Small Bowel Resection ◽

Uneventful Recovery ◽

Mortality And Morbidity ◽

Delay In Diagnosis ◽

Risk Of Mortality ◽

Published Report ◽

Femoral Ring ◽

The Right

Introduction. Femoral hernias are at high risk of strangulation due to the narrow femoral canal and femoral ring. This can lead to symptoms of obstruction or strangulation requiring emergency surgery and possible bowel resection. To our knowledge, there is only one previous published report of bilateral strangulated femoral hernia. We present our case of this phenomenon.Case Report. An 86-year-old woman presented with symptoms of small bowel obstruction. Examination revealed two tender lumps in the area of the femoral triangle. CT scan revealed bilateral femoral hernias. Both hernias were repaired and a small bowel resection on the right side was performed with side to side anastomosis. She made an uneventful recovery.Conclusion. Bilateral femoral hernias are a rare occurrence with only one reported case of bilateral strangulation. Our case highlights the importance of meticulous history taking and clinical examination as any delay in diagnosis will increase the risk of mortality and morbidity for the patient. Hernias should always be considered as a cause if one presents with symptoms of abdominal pain or obstruction.

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Relation of Small Bowel Resection to Nutrition in Man

Gastroenterology ◽

10.1016/s0016-5085(60)80035-2 ◽

1960 ◽

Vol 38 (4) ◽

pp. 605-615 ◽

Cited By ~ 36

Author(s):

M.H. Kalser ◽

J.L.A. Roth ◽

H. Tumen ◽

T.A. Johnson

Keyword(s):

Small Bowel ◽

Bowel Resection ◽

Small Bowel Resection

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The effect of pre-resection obesity on post-resection body composition after 75% small bowel resection in rats

Scientific Reports ◽

10.1038/s41598-021-92510-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Neesha S. Patel ◽

Ujwal R. Yanala ◽

Shruthishree Aravind ◽

Roger D. Reidelberger ◽

Jon S. Thompson ◽

...

Keyword(s):

Body Weight ◽

Small Bowel ◽

Lean Mass ◽

Bowel Resection ◽

Small Bowel Resection ◽

High Fat ◽

Low Fat ◽

Low Fat Diet ◽

Massive Resection ◽

Obese Rats

AbstractIn patients with short bowel syndrome, an elevated pre-resection Body Mass Index may be protective of post-resection body composition. We hypothesized that rats with diet-induced obesity would lose less lean body mass after undergoing massive small bowel resection compared to non-obese rats. Rats (CD IGS; age = 2 mo; N = 80) were randomly assigned to either a high-fat (obese rats) or a low-fat diet (non-obese rats), and fed ad lib for six months. Each diet group then was randomized to either underwent a 75% distal small bowel resection (massive resection) or small bowel transection with re-anastomosis (sham resection). All rats then were fed ad lib with an intermediate-fat diet (25% of total calories) for two months. Body weight and quantitative magnetic resonance-determined body composition were monitored. Preoperative body weight was 884 ± 95 versus 741 ± 75 g, and preoperative percent body fat was 35.8 ± 3.9 versus 24.9 ± 4.6%; high-fat vs. low fat diet, respectively (p < 0.0001); preoperative diet type had no effect on lean mass. Regarding total body weight, massive resection produced an 18% versus 5% decrease in high-fat versus low-fat rats respectively, while sham resection produced a 2% decrease vs. a 7% increase, respectively (p < 0.0001, preoperative vs. necropsy data). Sham resection had no effect on lean mass; after massive resection, both high-fat and low-fat rats lost lean mass, but these changes were not different between the latter two rat groups. The high-fat diet and low-fat diet induced obesity and marginal obesity, respectively. The massive resection produced greater weight loss in high-fat rats compared to low-fat rats. The type of dietary preconditioning had no effect on lean mass loss after massive resection. A protective effect of pre-existing obesity on lean mass after massive intestinal resection was not demonstrated.

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A very persistent chicken bone: two separate perforations from the same foreign object 2 months apart

BMJ Case Reports ◽

10.1136/bcr-2018-228050 ◽

2019 ◽

Vol 12 (5) ◽

pp. e228050

Author(s):

Andrew James Brown ◽

Thomas Whitehead-Clarke ◽

Vera Tudyka

Keyword(s):

Small Bowel ◽

Bowel Perforation ◽

Linear Structure ◽

Small Bowel Resection ◽

Emergency Laparotomy ◽

Small Bowel Perforation ◽

Chicken Bone ◽

Abdomen Ct ◽

Distal Migration ◽

The Right

A 56-year-old man presented acutely with abdominal pain and raised inflammatory markers. Initial CT images demonstrated acute inflammation in the right upper quadrant surrounding a high-density linear structure. The appearance was of a chicken bone causing a contained small bowel perforation. This was managed conservatively with intravenous antibiotics and the patient was discharged 10 days later. The same patient returned to the hospital 2 months later, once again with an acute abdomen. CT imaging on this occasion showed distal migration of the chicken bone as well as free gas and fluid indicative of a new small bowel perforation. The patient underwent an emergency laparotomy, washout and small bowel resection. No foreign body was found at laparotomy or in the histopathology specimen. The postoperative course was complicated by an anastomotic leak. A further CT on that admission demonstrated that the chicken bone had migrated to the rectum!

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Pituitary hormones and the small bowel: effect of hypophysectomy on intestinal adaptation to small bowel resection in the rat

European Journal of Clinical Investigation ◽

10.1111/j.1365-2362.1979.tb01677.x ◽

1979 ◽

Vol 9 (2) ◽

pp. 115-127 ◽

Cited By ~ 26

Author(s):

BRYCE TAYLOR ◽

GERARD M. MURPHY ◽

R. HERMON DOWLING

Keyword(s):

Small Bowel ◽

Bowel Resection ◽

Intestinal Adaptation ◽

Small Bowel Resection ◽

Pituitary Hormones

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Pathophysiological correlates of two unique renal tubule lesions in rats with intestinal resection

AJP Renal Physiology ◽

10.1152/ajprenal.00033.2006 ◽

2006 ◽

Vol 291 (5) ◽

pp. F1061-F1069 ◽

Cited By ~ 7

Author(s):

Elaine Worcester ◽

Andrew Evan ◽

Sharon Bledsoe ◽

Mark Lyon ◽

Mark Chuang ◽

...

Keyword(s):

Calcium Phosphate ◽

Small Bowel ◽

Bowel Resection ◽

Cell Damage ◽

Intestinal Resection ◽

Small Bowel Resection ◽

Renal Tissue ◽

Apical Surface ◽

Crystal Deposition ◽

Oxalate Excretion

Rats with small bowel resection fed a high-oxalate diet develop extensive deposition of calcium oxalate (CaOx) and calcium phosphate crystals in the kidney after 4 mo. To explore the earliest sites of renal crystal deposition, rats received either small bowel resection or transection and were then fed either standard chow or a high-oxalate diet; perfusion-fixed renal tissue from five rats in each group was examined by light microscopy at 2, 4, 8, and 12 wk. Rats fed the high-oxalate diet developed birefringent microcrystals at the brush border of proximal tubule cells, with or without cell damage; the lesion was most common in rats with both resection and a high-oxalate diet (10/19 with the lesion) and was significantly correlated with urine oxalate excretion ( P < 0.001). Rats with bowel resection fed normal chow had mild hyperoxaluria but high urine CaOx supersaturation; four of these rats developed birefringent crystal deposition with tubule plugging in inner medullary collecting ducts (IMCD). Two rats fed a high-oxalate diet also developed this lesion, which was correlated with CaOx supersaturation, but not oxalate excretion. Tissue was examined under oil immersion, and tiny birefringent crystals were noted on the apical surface of IMCD cells only in animals with IMCD crystal plugging. In one animal, IMCD crystals were both birefringent and nonbirefringent, suggesting a mix of CaOx and calcium phosphate. Overall, these animals demonstrate two distinct sites and mechanisms of renal crystal deposition and may help elucidate renal lesions seen in humans with enteric hyperoxaluria and stones.

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Cocaine-induced mesenteric ischaemia requiring small bowel resection

BMJ Case Reports ◽

10.1136/bcr-2020-238593 ◽

2021 ◽

Vol 14 (1) ◽

pp. e238593

Author(s):

Asya Veloso Costa ◽

Asiya Zhunus ◽

Rehana Hafeez ◽

Arsh Gupta

Keyword(s):

Small Bowel ◽

Social History ◽

Bowel Resection ◽

Early Recognition ◽

Small Bowel Resection ◽

Emergency Laparotomy ◽

Mesenteric Ischaemia ◽

Bowel Ischaemia ◽

Systemic Complications ◽

Gastrointestinal Complications

Cocaine use causes profound vasoconstriction leading to various systemic complications. Gastrointestinal complications such as mesenteric ischaemia are difficult to recognise and may result in serious consequences if not treated promptly. We report on the case of a 47-year-old man presenting with mesenteric ischaemia on a background of acute on chronic cocaine consumption, where diagnosis was not evident until second presentation. He underwent an emergency laparotomy with small bowel resection and jejunostomy formation and made a good recovery with eventual reversal surgery. The literature on cocaine-induced bowel ischaemia shows significant variability in presentation and outcome. Laboratory investigations are non-specific, and early recognition is vital. Given the increasing recreational use of cocaine in the UK, it is imperative to have a high clinical index of suspicion for mesenteric ischaemia in patients presenting with non-specific abdominal pain, and to ensure a detailed social history covering recreational drug use is not forgotten.

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