Short bowel syndrome

Background

• Well-recognized complication of gastric bypass
• Rapid post-prandial gastric emptying, release of gastric hormones, splanchnic vasodilation
• Hyperinsulinemic and hypoglycemic state

Clinical Features

• Nausea/vomiting, bloating, abdominal cramps, diarrhea, diaphoresis
  • Early dumping= symptoms 30-60min after a meal
  • Late dumping= symptoms 1-3 hours after a meal

Differential Diagnosis

Diffuse Abdominal pain

• Abdominal aortic aneurysm
  • Aortocaval fistula
• Acute gastroenteritis
• Aortoenteric fisulta
• Appendicitis (early)
• Bowel obstruction
  • Large bowel obstruction
    • Ogilvie's syndrome
  • Small bowel obstruction
  • Malignant bowel obstruction
• Bowel perforation
• Diabetic ketoacidosis
• Gastroparesis
• Hernia
• Hypercalcemia
• Inflammatory bowel disease
• Mesenteric ischemia
  • Mesenteric vein thrombosis
• Pancreatitis
• Peritonitis
• Sickle cell crisis
• Spontaneous bacterial peritonitis
• Volvulus

Evaluation

• See Abdominal Pain
• Diagnosis of exclusion

Management

• Dietary Modifications
  • Avoid highly concentrated foods
  • Separate eating and drinking
• Octreotide
  • Positive case reports

Disposition

• Home if other diagnoses excluded and able to tolerate oral intake

See Also

Gastric bypass surgery

References

O'Brien M. Acute Abdominal Pain In: Tintinalli's Emergency Medicine. 7th ed. McGraw-Hill. 2011:Chapter 74