Skip to main content
NCBI home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 1978 May;54(631):323–327. doi: 10.1136/pgmj.54.631.323

The problems of massive small bowel resection and difficulties encountered in management.

A A Barros D'Sa, T G Parks, A D Roy
PMCID: PMC2425143  PMID: 97646

Abstract

Massive small bowel resection is imperative in the management of several pathological conditions and is accompanied by high operative mortality. In those that survive, serious nutritional disturbances are inevitable. Intestinal adaptation is said to occur but cannot be relied upon. Long-term parenteral nutrition is problematical and often unsuccessful. Many surgical procedures have been adopted in an effort to improve prognosis and have been found wanting. Controlled experimental studies in the use of reversed segments and a limited number of reported clinical cases using the method after massive resection suggest that this technique may improve the function of the residual intestine to such an extent that other supportive measures are unnecessary.

Full text

PDF
323

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ALTHAUSEN T. L., DOIG R. K., UYEYAMA K., WEIDEN S. Digestion and absorption after massive resection of the small intestine. II. Recovery of the absorptive function as shown by intestinal absorption tests in two patients and a consideration of compensatory mechanisms. Gastroenterology. 1950 Sep;16(1):126–139. [PubMed] [Google Scholar]
  2. Barros D'sa A. A., Kennedy T. L., Buchanan K. D., Parks T. G. Proceeding: Gastro-intestinal hormonal responses following massive small bowel resection. Br J Surg. 1975 Feb;62(2):152–152. [PubMed] [Google Scholar]
  3. Barros d'sa A. A., Kennedy T. L., Parks T. G. Proceedings: Immediate and delayed segmental reversal after massive small bowel resection. Br J Surg. 1976 Aug;63(8):666–666. [PubMed] [Google Scholar]
  4. Buxton B. Small bowel resection and gastric acid hypersecretion. Gut. 1974 Mar;15(3):229–238. doi: 10.1136/gut.15.3.229. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Chen K. M. Massive resection of the small intestine. Surgery. 1969 Jun;65(6):931–938. [PubMed] [Google Scholar]
  6. D'Sa A. B. Letter: Reversed loops in the short gut syndrome. Br Med J. 1975 Aug 30;3(5982):543–543. doi: 10.1136/bmj.3.5982.543-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. D'sa A. A., Buchanan K. D. Role of gastrointestinal hormones in the response to massive resection of the small bowel. Gut. 1977 Nov;18(11):877–881. doi: 10.1136/gut.18.11.877. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Dubost C., Bitoun A., Celerier M., Laffitte P., Bernier J. J. Entérectomie totale après avulsion du jéjuno-iléon à travers une plaie du recto-sigmoïde. Réflexions sur les possibilités de survie sans intestine. Chirurgie. 1972 May;98(7):455–461. [PubMed] [Google Scholar]
  9. Ellis H., Coll I. Antiperistaltic segment for profuse ileostomy diarrhoea. Br Med J. 1968 Mar 2;1(5591):556–557. doi: 10.1136/bmj.1.5591.556. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. FLETCHER R. F., HENLY A. A., SAMMONS H. G., SQUIRE J. R. A case of magnesium deficiency following massive intestinal resection. Lancet. 1960 Mar 5;1(7123):522–525. doi: 10.1016/s0140-6736(60)90453-0. [DOI] [PubMed] [Google Scholar]
  11. FREDERICK P. L., SIZER J. S., OSBORNE M. P. RELATION OF MASSIVE BOWEL RESECTION TO GASTRIC SECRETION. N Engl J Med. 1965 Mar 11;272:509–514. doi: 10.1056/NEJM196503112721004. [DOI] [PubMed] [Google Scholar]
  12. GIBSON L. D., CARTER R., HINSHAW D. B. Segmental reversal of small intestine after massive bowel resection. Successful case with follow-up examination. JAMA. 1962 Dec 1;182:952–954. doi: 10.1001/jama.1962.03050480058015d. [DOI] [PubMed] [Google Scholar]
  13. Grundberg A. B., Lopez A. S., Dragstedt L. R., 2nd Effect of intestinal reversal and massive resection on gastric secretion. Arch Surg. 1967 Mar;94(3):326–329. doi: 10.1001/archsurg.1967.01330090020005. [DOI] [PubMed] [Google Scholar]
  14. Herrington J. L., Jr, Edwards W. H., Carter J. H., Sawyers J. L. Treatment of severe postvagotomy diarrhea by reversed jejunal segment. Ann Surg. 1968 Sep;168(3):522–541. doi: 10.1097/00000658-196809000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. KINNEY J. M., GOLDWYN R. M., BARR J. S., Jr, MOORE F. D. Loss of the entire jejunum and ileum, and the ascending colon. Management of a patient. JAMA. 1962 Feb 17;179:529–532. doi: 10.1001/jama.1962.03050070000009b. [DOI] [PubMed] [Google Scholar]
  16. KOGAN E., SCHAPIRA A., JANOWITZ H. D., ADLERSBERG D. Malabsorption following extensive small intestinal resection including inadvertent gastro-ileostomy. J Mt Sinai Hosp N Y. 1957 May-Jun;24(3):399–424. [PubMed] [Google Scholar]
  17. KREMEN A. J., LINNER J. H., NELSON C. H. An experimental evaluation of the nutritional importance of proximal and distal small intestine. Ann Surg. 1954 Sep;140(3):439–448. doi: 10.1097/00000658-195409000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Kerpel-Fronius E., Miltényi M., Görgényi A. Osmotic diarrhea due to high sodium chloride intake following subtotal resection to the small intestine. Digestion. 1970;3(1):20–24. doi: 10.1159/000196984. [DOI] [PubMed] [Google Scholar]
  19. Lack L., Weiner I. M. Role of the intestine during the enterohepatic circulation of bile salts. Gastroenterology. 1967 Feb;52(2):282–287. [PubMed] [Google Scholar]
  20. MACKBY M. J., RICHARDS V., GILFILLAN R. S., FLORIDIA R. METHODS OF INCREASING THE EFFICIENCY OF RESIDUAL SMALL BOWEL SEGMENTS: A PRELIMINARY STUDY. Am J Surg. 1965 Jan;109:32–38. doi: 10.1016/s0002-9610(65)80099-x. [DOI] [PubMed] [Google Scholar]
  21. Meyer H. W. Extensive resection of small and large intestine. A further twenty-two year follow-up report. Ann Surg. 1968 Aug;168(2):287–289. doi: 10.1097/00000658-196808000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Osborne M. P., Frederick P. L., Sizer J. S., Blair D., Cole P., Thum W. Mechanism of gastric hypersecretion following massive intestinal resection. Clinical and experimental observations. Ann Surg. 1966 Oct;164(4):622–634. doi: 10.1097/00000658-196610000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Poth E. J. Use of gastrointestinal reversal in surgical procedures. Am J Surg. 1969 Dec;118(6):893–899. doi: 10.1016/0002-9610(69)90253-0. [DOI] [PubMed] [Google Scholar]
  24. REED D. L., COON W. W. THROMBOEMBOLISM IN PATIENTS RECEIVING PROGESTATIONAL DRUGS. N Engl J Med. 1963 Sep 19;269:622–624. doi: 10.1056/NEJM196309192691207. [DOI] [PubMed] [Google Scholar]
  25. Rygick A. N., Nasarov L. U. Antiperistaltic displacement of an ileal loop without twisting its mesentery. Dis Colon Rectum. 1969 Nov-Dec;12(6):409–411. doi: 10.1007/BF02617723. [DOI] [PubMed] [Google Scholar]
  26. Schiller W. R., DiDio L. J., Anderson M. C. Production of artificial sphincters. Ablation of the longitudinal layer of the intestine. Arch Surg. 1967 Sep;95(3):436–442. doi: 10.1001/archsurg.1967.01330150112015. [DOI] [PubMed] [Google Scholar]
  27. Sedgwick C. E., Goodman A. A. Short bowel syndrome. Surg Clin North Am. 1971 Jun;51(3):675–680. doi: 10.1016/s0039-6109(16)39443-9. [DOI] [PubMed] [Google Scholar]
  28. Vayre P., Hureau J., Soyer R. Utilisation d'une interposition colique segmentaire antiperistaltique pour freiner le transit grele après résection étendue (note préliminaire) Ann Chir. 1967 May;21(9):521–526. [PubMed] [Google Scholar]
  29. Venables C. W., Ellis H., Smith A. D. Antiperistaltic segments after massive intestinal resections. Lancet. 1966 Dec 24;2(7478):1390–1394. doi: 10.1016/s0140-6736(66)90424-7. [DOI] [PubMed] [Google Scholar]
  30. Waddell W. R., Kern F., Jr, Halgrimson C. G., Woodbury J. J. A simple jejunocolic "valve". For relief of rapid transit and the short bowel syndrome. Arch Surg. 1970 Apr;100(4):438–444. doi: 10.1001/archsurg.1970.01340220114020. [DOI] [PubMed] [Google Scholar]
  31. Weinstein L. D., Shoemaker C. P., Hersh T., Wright H. K. Enhanced intestinal absorption after small bowel resection in man. Arch Surg. 1969 Nov;99(5):560–562. doi: 10.1001/archsurg.1969.01340170012003. [DOI] [PubMed] [Google Scholar]
  32. Westergaard H., Dietschy J. M. Normal mechanisms of fat absorption and derangements induced by various gastrointestinal diseases. Med Clin North Am. 1974 Nov;58(6):1413–1427. doi: 10.1016/s0025-7125(16)32081-8. [DOI] [PubMed] [Google Scholar]
  33. Zurier R. B., Campbell R. G., Hashim S. A., Van Itallie T. B. Use of medium-chain triglyceride in management of patients with massive resection of the small intestine. N Engl J Med. 1966 Mar 3;274(9):490–493. doi: 10.1056/NEJM196603032740904. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES