title: Massive small bowel resection during pregnancy causing short bowel syndrome.
abstract: Massive small bowel infarction in pregnancy is rare but has devastating complications. Diagnosis is difficult because pregnancy masks the symptoms. Our aim was to assess risk factors and outcomes of massive resection associated with pregnancy. We conducted a review of nine patients  with short bowel syndrome (SBS) secondary to massive bowel resection during pregnancy. The most common cause of bowel resection was midgut volvulus in seven patients. Four of these also had malrotation. Three others had previous abdominal operations, including gastric bypass. The two remaining  patients had vascular insufficiency. Five of the nine patients presented after a cesarean delivery. There were three fetal deaths. Resulting small bowel length was less than 60 cm in all but one patient. All patients required parenteral nutrition (PN). Seven patients developed significant  complications related to SBS and long-term PN. Four patients underwent transplantation. Massive small bowel resection during pregnancy is a devastating complication, which requires a high degree of suspicion to diagnose. Most patients have risk factors, which include previous surgery, congenital  malrotation, and a hypercoagulable state. Surviving patients usually need long-term PN or transplantation.
authors.affiliation: Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska 68198-3280, USA. eboland@unmc.edu
authors.forename: Elena
authors.initials: E
authors.lastname: Boland
authors.forename: Jon S
authors.initials: JS
authors.lastname: Thompson
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Grant
authors.forename: Jean
authors.initials: J
authors.lastname: Botha
authors.forename: Alan N
authors.initials: AN
authors.lastname: Langnas
authors.forename: David F
authors.initials: DF
authors.lastname: Mercer
mesh_terms: D000328:Adult; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery; D007421:Intestine, Small / Q000601:surgery*; D009329:Nebraska / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D012189:Retrospective Studies; D012778:Short Bowel Syndrome / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors; D055815:Young Adult