Management of patients with a short bowel

Table 1 Reasons for a short bowel (less than 200 cm small bowel) [25]

	Jejunum-colon	Jejunostomy
Total (sex)	38 (26F)*	46 (31F)
Age	46 (7-70)	42 (16-68)
Median jejunal length (cm)	90 (0-190)	115 (20-190)
Diagnosis
Crohn’s disease	16	33
Ischaemia	6	2
Irradiation	5	3
Ulcerative colitis	-	5
Volvulus	5	-
Adhesions	4	1
Diverticular disease	1	1
Desmoid tumour	1	1

^*:7 had an ileocaecal valve and 31 a jejuno-colic anastomosis.

Table 2 Guide to bowel length and long-term fluid/nutritional support needed by patients with a short bowel [5,37,[38],[74]

Jejunal length (cm)	Jejunum-colon	Jejunostomy
0-50	PN	PN+PS
51-100	ON	PN+PS*
101-150	None	ON+OGS
151-200	None	OGS

^*:at 85-100 cm may need PS only; PN: Parenteral nutrition; PS: Parenteral saline (+/-magnesium); ON: Oral (or enteral) nutritinon; OGS: Oral (or enteral) glucose/saline solution

Table 3 The modified WHO cholera rehydration solution Sodium chloride 60 mmol (3.5 gm)

Sodium bicarbonate (or citrate)	30 mmol (2.5 gm) (2.9 gm)
Glucose	110 mmol (20 gm)
Tap water	one litre
Alternative rehydration solution
Sodium chloride	120 mmol (7 gm)
Glucose	44 mmol (8 gm)
Tap water	one litre

Table 4 Summary of the problems of a short bowel

	Jejunum-colon	Jejunostomy
Presentation	gradual, diarrhoea and undernutrition	acute fluid losses
Water, sodium and	uncommon in the	common
magnesium depletion	long-term
Nutrient malabsorption	common*	very common
D(-)lactic acidosis	occasionally	none
Renal stones (calcium oxalate)	25%	none
Gallstones (pigment)	45%	45%
Adaptation	functional adaptation	no evidence
Social problems	diarrhoea dehydration dependency on treatment	high stomal output

^*: bacterial fermentation of carbohydrate salvages some energy, but D (-) lactic acidosis can occur if the diet is high in mono and oligosaccharides.