Postoperative short bowel syndrome.
BACKGROUND
Unanticipated massive resection after intraabdominal procedures is an increasing cause of short bowel syndrome (SBS). Our aim was to determine the frequency and potential mechanisms of postoperative SBS.


METHODS
We reviewed retrospectively the clinical course of 210 adult patients with SBS evaluated over a 20-year period.


RESULTS
Fifty-two (25%) patients had postoperative SBS. The initial operations included colectomy (n=20), hysterectomy (n=8), appendectomy (n=5), gastric bypass (n=5), and other (n=14). Intestinal obstruction (n=38) was the most common reason for resection leading to SBS, either from adhesions (n=26) or volvulus (n=12). Postoperative intestinal ischemia led to resection in 14 patients. SBS occurred from 1 day postoperatively to years later, with 16 (30%) intestinal resections occurring within 1 month. Patients undergoing resection for intestinal ischemia were more likely to undergo resection during the first month than were patients with adhesions and volvulus (86% versus 4% and 25%,respectively, p < 0.05): Patients undergoing resection for ischemia and volvulus were more likely to have remnant length<60 cm compared with those with adhesions (57% and 58% versus 23%, respectively, p < 0.05). Patients undergoing resection for adhesive obstruction were more likely to undergo multiple resections. Thirty-five (67%) patients required longterm parenteral nutrition. Seven (13%) patients died, three in the early postoperative period and four from complications of SBS.


CONCLUSIONS
SBS is a potential postoperative complication of intraabdominal procedures and accounts for a considerable proportion of tertiary referrals for SBS. Surgical treatment of postoperative obstruction after common surgical procedures is the most frequent cause. Preventing adhesions, avoiding technical errors, diagnosing a potentially ischemic intestine in a timely manner, and approaching the frozen abdomen cautiously are important strategies for preventing this condition.
Thompson
Jon S
JS
Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198-3280, USA.
DiBaise
John K
JK
Iyer
Kishore R
KR
Yeats
Melania
M
Sudan
Debra L
DL
D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000009:adverse effects; D002423:Cause of Death; D003082:Colectomy / Q000009:adverse effects; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D007410:Intestinal Diseases / Q000601:surgery; D007415:Intestinal Obstruction / Q000601:surgery; D045822:Intestinal Volvulus / Q000601:surgery; D007422:Intestines / Q000098:blood supply; D007511:Ischemia / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D011183:Postoperative Complications; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000209:etiology*; D000267:Tissue Adhesions / Q000601:surgery