Short Bowel Syndrome

Introduction Short bowel syndrome (SBS) is defined as intestinal failure due to a loss of intestine resulting in inadequate length of bowel for maintaining the nutrition and hydration of the individual without either intravenous or oral supplementation. With some reported exceptions, the minimum length of small bowel required for infant survival on enteral feeds is generally 25 cm in the presence of an intact ileocaecal valve (ICV) and colon, and 40 cm without an ICV and large bowel. Note that norms of intestinal length vary considerably, with a range of 250 cm to 300 cm of small bowel at term. The estimated length in a preterm infant of 26 and 32 weeks gestation is 70 cm and 120 cm, respectively. Thus, gestational age is an important factor. However, an infant is considered to have SBS when he or she behaves as if SBS is present, and the infant should be treated as such. The intestine has the ability to adapt over time such that up to half of patients with SBS who initially require total parenteral nutrition (TPN) may be weaned off and gradually gain independence from TPN. However, in the absence of the availability of TPN, SBS carries a dismal prognosis. The management of SBS is resource-intense, requiring the availability of intensive care, TPN, and expert medical and surgical intervention. Even in optimal settings, infants and children with SBS suffer extensive morbidity and mortality. In most countries in Africa where TPN is not available, the outcomes are poor.