Short-bowel syndrome.

Short-bowel syndrome refers to the clinical sequelae of resection of a substantial portion of the small intestine. Features of diarrhea, dehydration, malabsorption, malnutrition, or weight loss generally occur, at least transiently, when more than 75% of the small intestine is resected, although other factors in addition to residual length affect clinical outcome. Adaptation of the remnant bowel has been well documented to occur over months to years following resection, although the agents responsible for this process are not well defined. Ambulatory total parenteral nutrition has greatly improved the prognosis of this syndrome over the last 25 years. We review the anatomical and the pathophysiological basis of this syndrome, discuss its clinical manifestations, and review current knowledge of intestinal adaptation. We also review medical and surgical therapeutic options for these patients, as well as dietary, enteral, and parenteral nutritional aspects of their care.