Massive Small Bowel Resection Post Infarction: How easy is the management of the resultant Short Bowel Syndrome?

Awe J.A.A¹, Ugwi, V² and Imarhiagbe, L³

¹(MBBS Ibadan; FWACS; FICS; FRCS), Consultant General Surgeon and Associate Professor of Surgery.

²(MBBS Benin) Surgical Registrar; Department of Surgery.

³(MBBS Benin) Medical Registrar; Department of Medicine. College of Health Sciences, Igbinedion University, Okada, Edo State, Nigeria.

*Corresponding Author’s Email: doset2007@yahoo.com   

Accepted 15 April, 2014

Abstract

Massive small bowel resection leaving behind a length of one hundred centimeter (100cm) or less of viable intestine as a result of massive small bowel infarction is usually carried out for a variety of reasons such as strangulated hernia, neglected post-operative intestinal adhesions or of varieties of vascular insufficiencies, that lead to reduction or total cutting off of the blood supply to the small bowel. This massive resection eventually results in what is termed the short bowel syndrome. Short bowel syndrome predominantly results in intestinal failure usually associated with a high degree of morbidity and mortality and a chronic malabsorptive state resulting in the clinical symptomatology of diarrhea, nutrient malabsorption, dysmotility, and bowel dilatation. The remaining bowel may undergo a process called adaptation, which may replace lost intestinal function. The pessimism expressed more than seventy (70) years ago concerning this syndrome is still shared by many physicians and surgeons till today. Definitive diagnosis of small bowel infarction is usually made at laparotomy. We the authors present this case of a thirty (30) year old female farmer admitted by the Obstetric and Gynecology department of our hospital as a case of suspected ruptured ectopic pregnancy but eventually found to have suffered massive small bowel infarction at laparotomy and the surgical unit was consulted while the patient was still on the operating table. The objective for presenting this paper is to warn surgeons to consider the development of bowel infarction as a complication of neglected post-operative adhesions in the differential diagnosis of acute surgical abdomen especially in females of child-bearing age with history or evidence of previous abdominal operation.

Keywords: Small Bowel, Infarction, Short Bowel Syndrome, Post-operative Adhesion.