Massive Small-Bowel Resection After Total Colectomy

The satisfaction derived from performing a lifesaving resection of strangulated necrotic bowel is often tempered by the consideration that an insufficient amount of bowel remains to sustain nutrition. The problem of massive bowel resection is well summarized by Jackson.¹ Probably the most extensive bowel resection in a patient who survived for a substantial period of time was reported by Martin et al.² This patient was a 46-year-old man in whom the third portion of the duodenum was anastomosed to the transverse colon after mesenteric artery occlusion. He survived for 316 days. Kaiser et al.³ recently studied the relation of small-bowel resection to nutrition in man and confirmed that patients with massive resections, and particularly those who had removal of the terminal ileum and ileocecal valve, had decreased fat absorption. It is noteworthy, however, that even with grossly abnormal fat absorption, weight gain was possible.

The patient reported