The Massive Bowel Resection Syndrome

SURGEONS must occasionally resect extensive lengths of bowel in disorders such as mesenteric thrombosis, volvulus, malignancy, ulcerative colitis, regional enteritis, and trauma. The malnutrition and bothersome diarrhea which may follow massive bowel resection is well known. The average length of the adult small intestine is 6.1 meters (20.5 feet).1The term "massive resection" has been applied to patients in whom more than 200 cm (7 feet) of small bowel has been resected.2When 90 cm (3 feet) or less of small intestine remains, severe problems ensue even though the colon is intact.3When a portion of the colon, and especially the ileocecal valve, is resected in addition to a large part of small intestine, the patient's clinical status may be precarious. These patients suffer from diarrhea, steatorrhea, hypoproteinemia, weight loss, and other nutritional disturbances (Table 1). To this condition we prefer to apply the term "massive bowel