Surgery Indications in short bowel

Quotes from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth -

"Surgery is indicated only for selected patients with any one of three conditions: (1) when the absorptive surface area is definitely too small to allow enteral feeding; (2) when severe dysmotility in grossly dilated loops entails stagnation of chyme; and (3) when intestinal transit time is too fast to allow sufficient absorption of nutrients. In the first group of patients, intestinal transplantation is the mainstay of surgical therapy. In the second group, peristalsis can be improved by intestinal tapering or tapering and lengthening. In the third group, antiperistaltic segments, colonic interposition, intestinal valves, and/or artificial invagination have been used in selected patients."

"Tapering is indicated in patients with sufficient intestinal length but severely dilated small bowel with impaired propulsive peristalsis. The intestinal content in the enlarged intestinal loops causes bacterial overgrowth, inflammation, and bacterial translocation with recurrent sepsis. Grossly dilated loops can be primarily due to an intentionally limited resection of small bowel in patients with intestinal atresia, or they can be the result of the process of intestinal adaptation with subsequent dilatation of the intestinal tract."