Encyclopedia of Health and Medicine

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short bowel syndrome Reduction in the structural
or functional length of the SMALL INTESTINE
that results in MALABSORPTION, chronic DIARRHEA,
and other disturbances of digestion. MALNUTRITION
is a common consequence. Short bowel syndrome
most often results from surgery that removes segments
of the small intestine as treatment for
Crohn’s disease, DIVERTICULAR DISEASE, cancers of
the small intestine, traumatic injury, and other
conditions that irreparably damage the small
intestine. Short bowel syndrome was a common
complication of a weight loss operation,
jejunoileal bypass, that surgeons no longer perform.
Functional short bowel syndrome also may
develop following severe COLITIS (such as may
occur with ESCHERICHIA COLI O157:H7 INFECTION) or
radiation GASTROENTERITIS.
Treatment options for short bowel syndrome
attempt to manage symptoms such as diarrhea as
well as to meet NUTRITIONAL NEEDS. Most people
who develop short bowel syndrome require PAR-
ENTERAL NUTRITION, a form of long-term intravenous
feeding. Surgical options include operations to
extend the remaining small intestine through various
procedures and SMALL BOWEL TRANSPLANTATION
or multivisceral transplantation (typically small
bowel and LIVER or small bowel, liver, STOMACH,
and PANCREAS). The extensive presence of lymphatic
tissue in the gastrointestinal tract creates
IMMUNE RESPONSE challenges with transplantation.
Liver and biliary dysfunctions (notably
CHOLESTASIS) are common complications of short
bowel syndrome, as the JEJUNUM and ILEUM produce
a number of DIGESTIVE HORMONES that help to
regulate liver activity and BILE release. When these
segments of the small intestine are missing or no
longer functional, the body has no secondary systems
to synthesize these hormones. Long-term
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total parenteral nutrition exacerbates liver and biliary
dysfunctions. These factors tend to lead to
LIVER FAILURE. Research directions for solutions to
the challenges of short bowel syndrome therapies
include explorations in IMMUNOTHERAPY (with a
focus on suppressing the immune response in
transplantation), pharmacotherapy (with a focus
on supplemental hormones), and surgical methods
that might improve small bowel function
without transplantation.
See also CYSTIC FIBROSIS; GUT-ASSOCIATED LYMPHOID
TISSUE (GALT); FOOD-BORNE ILLNESSES; INFLAMMATORY
BOWEL DISEASE (IBD); MUCOSA-ASSOCIATED LYMPHOID
TISSUE (MALT); RADIATION THERAPY.
sitz bath A small basin designed to accommodate
the perineal and rectal areas, with the water
level only to the hips. Numerous commercial
products are available for ease of use at home.
Placing a shallow amount of water in the regular
bathtub accomplishes the same objective, which is
to soothe irritated tissues caused by, for example,
EPISIOTOMY incision, ANAL FISSURE, and HEMORRHOIDS.
The water may contain medications or herbs for
additional therapeutic effect.
See also MEDICINAL HERBS AND BOTANICALS.
small bowel transplantation Replacement of a
diseased SMALL INTESTINE with a cadaver donor
small intestine. Small bowel transplantation is a
final treatment option for SHORT BOWEL SYNDROME
or other circumstances in which there is total loss
of small intestine structure or function. The gastroenterologist
may consider small bowel transplantation
when all other treatments, including
total PARENTERAL NUTRITION, have failed. Small
bowel transplantation is an extraordinarily complex
procedure. The complication rate is high, and