title: [Problems of alimentation in massive intestinal resections].
abstract: Before reviewing the consequences of extensive exeresis of the small intestine, the physiology of the entero-hepatic circulation of bile salts, the absorption of triglycerides and the varying sites of absorption of foodstuffs at intestinal level are discussed. It has been found that massive (i.e. at least 2/3) removal of the small intestine is incompatible with life owing to the onset of serious metabolic disturbances due to the increase in the speed of transit of foodstuffs from stomach to colon. Malabsorption of lipides causes steatorrhoea and is often associated with choleriform diarrhoea owing to the massive losses of water and electrolytes (Na, Cl, Ca, Mg). Some surgical techniques are illustrated and the local compensation mechanisms (anatomical adaptation of the intestinal mucosa, functional adaptation) designed to prolong transit time are described. Feeding must be parenteral for the first 2--3 months and oral during the alimentary adaptation phase.
mesh_terms: D002446:Celiac Disease / Q000209:etiology; D003967:Diarrhea / Q000209:etiology; D006801:Humans; D007422:Intestines / Q000601:surgery*; D008286:Malabsorption Syndromes / Q000209:etiology / Q000517:prevention & control*; D008659:Metabolic Diseases / Q000209:etiology / Q000517:prevention & control*; D010288:Parenteral Nutrition; D011182:Postoperative Care; D011183:Postoperative Complications; D014882:Water-Electrolyte Balance
vernacular_title: Problemi di alimentazione nelle resezioni intestinali massive.