Case history
Case history #1
A 60-year-old man with atrial fibrillation presents with sudden-onset, severe abdominal pain. On physical examination he is found to have findings consistent with an acute abdomen, and undergoes an emergency exploratory laparotomy. He is found to have a superior mesenteric artery embolism causing ischemia and necrosis of his small bowel. The patient has a subtotal small bowel resection, a jejunostomy is created, and parenteral nutrition is started for nutritional support. In order to maximize water, electrolyte, and energy absorption, the patient undergoes a second surgery for a jejunocolic anastomosis 2 days later.
Case history #2
A 40-year-old woman with long-standing Crohn disease and extensive past surgical history notable for three small bowel resections and a partial colectomy presents to the hospital with failure to thrive. She is very weak and has lost approximately 13 kg in the last year, despite having a normal appetite. She complains of diarrhea following every meal. On examination, she is dehydrated and thin, has signs of malnutrition, and has multiple surgical scars on her abdomen. Investigations reveal deficiencies of vitamins A, D, and B12, and folate (B9). She has no evidence of a malignancy or active Crohn disease.
Other presentations
The majority of patients with SBS have undergone bowel resection to treat Crohn disease, abdominal trauma, or ischemic bowel. Children may present with bowel atresia, or may undergo bowel resection to treat intestinal atresia, midgut volvulus, or necrotizing enterocolitis, and develop SBS as a complication of surgery. Less common presentations include patients with extensive abdominal radiation injury and children who develop bowel ischemia as a result of gastroschisis, a congenital abnormality.
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