Massive resection of the small intestine

A massive resection of the small intestine may be defined as a resection of more than 30 cm. Resection in the pediatric age group usually occurs following surgical catastrophes in the neonatal period. These include volvulus neonatorum secondary to a developmental anomaly, such as omphalocele or malrotation; obstruction from multiple atretic areas requiring resection; necrotizing enterocolitis; and sometimes meconium ileus, intussusception, or long-segment Hirschsprung's disease with small-intestinal involvement. Extensive Crohn's disease in the older child may sometimes require massive small-intestinal resection. The clinical syndrome resulting from massive small-intestinal resection is referred to as the “short-gut syndrome.” It is characterized by diarrhea and reduced absorption of all nutrients, minerals, and vitamins. The characteristic disabilities suffered by these children are the result of gross alterations in nutrient absorption. The resection of the entire duodenum frequently results in anemia and osteomalacia. The problems encountered following massive small-intestinal resection fall into two groups—first, the immediate post-operative problems and, second, the long-term problems. The major immediate problems are severe diarrhea with associated fluid and electrolyte losses and the resultant inability to retain enough calories to maintain weight. The long-term problems relate more to the severity of the malabsorption state resulting from loss of absorptive capacity and the effect this has on nutrition and growth.