Massive enterectomy: Indications and management

Massive enterectomy in adults may be necessary for Crohn's disease in young patients or for intestinal infarction in older patients. Other indications are rare. When less than 3 m of small bowel remain, a number of serious metabolic and nutritional abnormalities occur. When 2 m or less remain, most patients have a limited work capacity as well, and many patients with less than 1 m of small bowel need parenteral nutrition at home on an indefinite basis. Correct management depends on an understanding of the disordered physiological state brought about by the resection and a realization that adaptation may occur. Based on these principles, the management of these patients in the operating room and during their subsequent rehabilitation is discussed.