Short bowel syndrome is exactly what the name sounds like - a condition in which the bowel is too short generally due to surgical resection. Most commonly, the need for surgical resection has occurred in infancy because babies are born with abnormal intestines or develop serious damage to the intestine. Older children may have short bowel syndrome due to trauma or inflammatory bowel disease, although this is rare in children.
Conditions in infancy include:
- intestinal atresias
- necrotizing enterocolitis
- meconium ileus
- Hirschsprung’s disease
The normal function of the intestine is to absorb fluid and nutrients. When the intestine cannot do this effectively, malabsorption occurs and results in complications. Most importantly, the child cannot gain weight or grow, but other problems also occur. When children are first diagnosed with short bowel syndrome, they often require special nutrition via a catheter in their veins (IV nutrition) which is called total parenteral nutrition or TPN. With this therapy, sugar, protein, fat and electrolytes are provided intravenously. The amount of this kind of nutrition is generally decreased over time as enteral nutrition (nutrition through the GI tract) is advanced and the intestine begins to tolerate more of the needed nutrition. This can be a slow process. When this kind of nutrition support is needed for months, children are considered to have intestinal failure.
Some of the common complications associated with short bowel syndrome include diarrhea, small bowel bacterial overgrowth, decreased bone density (osteopenia or osteoporosis), kidney stones, and, for those who require parenteral nutrition, blood stream infections, intestinal failure-associated liver disease, and thromboses (fixed blood clots) associated with the need for central lines.
The majority of children that we care for are able to wean from parenteral nutrition to either all oral or a combination of oral and enteral feedings. The time it takes to reach this goal varies from one child to another.