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Metabolic Effects of Small Bowel Reversal in Treatment of the Short Bowel Syndrome

Douglas W. Wilmore, MD; Charles J. Johnson, MD
Arch Surg. 1968;97(5):784-791. doi:10.1001/archsurg.1968.01340050124019.
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MASSIVE bowel resection remains a clinical catastrophe.1 While patients who survive removal of 50% of the small bowel can live relatively normal lives, serious problems occur when less than 8 feet of bowel remains. Severe diarrhea, dehydration, hypovolemia, acidosis, electrolyte imbalance, renal failure, steatorrhea, hypoproteinemia, weight loss, and cachexia characterize the gastrointestinal insufficiency of the short-bowel syndrome.

Small-bowel reversal is a method of increasing intestinal absorption after massive bowel resection.2-4 The short antiperistaltic segment, anastomosed terminally to the remaining small bowel, maintains its functional polarity and acts as an incomplete small-bowel obstruction.5 Gastrointestinal transit is delayed, and contact time between nutrients and intestinal mucosa is increased, allowing more effective absorption of foodstuffs from the bowel lumen.

Hammer et al,2 utilizing these facts, evaluated reversed segments in dogs after 80% bowel resection. Control animals with comparable amounts of gastrointestinal absorptive surface died from dehydration, electrolyte imbalance,


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