Publication:

Short-term outcomes following massive small bowel resection: our experience of 23 cases

Background Short bowel syndrome (SBS) is a condition where a significant portion of the small intestine is lost/ absent, either congenitally or secondary to surgical resection. Complications arising due to the short length of the remnant bowel account for the high morbidity and mortality. In this case series, we describe our experience with 23 patients who underwent major intestinal resection.

Methods Retrospective data were retrieved from departmental records from January 2017 to June 2024 of patients who underwent major small bowel resection at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry with a remnant small bowel length of <200cm.

Results After excluding patients with incomplete records, data from 23 patients were analyzed. Mesenteric ischemia due to thrombosis of the superior mesenteric artery or vein was the most common etiology behind massive bowel resection. Most of the patients required intensive care in the immediate postoperative period, with ventilator support. The wound related complications included superficial and deep surgical site infection (52.2%), wound dehiscence (21.7%), and stomal necrosis (26.1%). Dyselectrolytemia, in the form of hyponatremia, was common in Type I (90%) and Type II SBS (80%), whereas it had a lower incidence in Type III SBS (28.6%), p value = 0.023. Early postoperative mortality occurred in 5 patients.

Conclusions The present case series shows the high morbidity and mortality associated with massive small bowel resection. Early initiation of enteral feeds, with or without parenteral supplementation, may help prevent dependence on parenteral nutrition and is associated with lower morbidity and mortality.