Short Bowel Syndrome

Description

Short bowel syndrome occurs when greater than 75-90% of small intestine is absent. It is most commonly caused by iatrogenic surgical resection, although congenital anomaly can occur. The remaining small intestine cannot adequately absorb nutrients and electrolytes, resulting in diarrhoea. If the ileocolic valve has been removed, a large number of bacteria is more likely to reach the small intestine. However, this may be only be transient as the remaining of the intestine can undergo adaptive hyperplasia. This syndrome does not necesary occur in all cases which have undergone intestinal resection.

This syndrome should ideally be avoided in the first instance. It is may be better to perform a second surgery 24-48 hours after the first surgery in order to avoid a large resection of the small intestine.

Diagnosis

Clinical Signs

• Small intestinal diarrhoea, often with udigested food particles in the faeces
• Severe weight loss

In cases which occur after surgical bowel resection, the presenting clinical signs is sufficient to make a diagnosis. In cases of congenital origin, a plain or contrast radiography is required.

Treatment

Dietary modification

• Small, frequent meals of highly digestible, low fat diet is recommended.
• Vitamin supplementation may be required.

Antimicrobials

• A secondary antibiotic responsive diarrhoea may result if the ileocaecal valve is removed.
• Metronidazole or tylosin can be given in these cases.

Antisecretory agents & antacids

• These may be needed in cases which are poorly responsive to lessen diarrhoea and gastric hypersecretion.
• Antisecretory agents such as loperamide, diphenoxylate.
• Antacids such as ranitidine, famotidine.

Nutritional support

• Total or partial parenteral nutrition may be required in some cases to provide adequate nutrition until adaptive hyperplasia takes place.
• At the same time, it is important to continue oral feeding to stimulate mucosal hypertrophy.

Prognosis

This is dependent on the length of the small intestine that remains. If adequate adaption occurs, the patient may respond well and eventually be ablet to consume near-normal diet. However, there will always be a limitation in the absoptive capacity of these animals. Some cases may respond poorly and can never be fed on a normal diet or some may die. Malnourished animals have a poorer prognosis.

References

• Ettinger, S.J. and Feldman, E. C. (2000) Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2 (Fifth Edition) W.B. Saunders Company.
• Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA
• Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition) Mosby Elsevier.