Short bowel syndrome

Alternative names
Small intestine insufficiency

Short bowel syndrome is condition of nutritional malabsorption related to the surgical removal or disease of a large portion of the small intestine.

Causes, incidence, and risk factors

When areas of the small intestine are removed surgically, there may not be enough surface area left in the remaining bowel to adequately absorb nutrients from food.

This condition is particularly likely to develop when one-half or more of the bowel is removed during surgery. Risk factors include diseases of the small intestine that may require surgical intervention such as regional enteritis or Crohn’s Disease. Necrotizing enterocolitis is a common cause of this syndrome in infants.


  • Floating stools  
  • Foul-smelling stools  
  • diarrhea  
  • Edema  
  • Weight loss  
  • Fatigue  
  • Pallor

Signs and tests

  • Chem 20 (reveals signs of malabsorption)  
  • CBC (reveals anemia)  
  • Fecal fat test


Treatment is aimed at relieving of symptoms.

A high-calorie and low-residue diet supplying essential vitamins and minerals is necessary. Anemia is treated with Vitamin B12, Folic acid, and increased dietary iron. Medications may be given to lengthen the time nutrients spend in the small intestine.

Parenteral nutrition (tube feeding through a vein or stomach tube) is often necessary if normal feeding is not delivering enough nutrients. Once the patient has stabilized, however, a return to normal eating may be tried.

Expectations (prognosis)

The condition may improve over time if it occurs as a result of surgery. Improvement of nutrient absorption and lengthening of food’s transit time through the intestine usually occurs with recovery from surgery.


  • Weight loss  
  • Malnutrition  
  • Pernicious anemia  
  • Combined systems disease (degenerative changes in the spinal cord and nerves due to vitamin B12 deficiency)  
  • Gallstones  
  • Bacterial overgrowth  
  • Metabolic acidosis (d-lactic acidosis)  
  • Kidney stones

Calling your health care provider

Call for an appointment with your health care provider if symptoms suggestive of short bowel syndrome develop, particularly if you have recently had bowel surgery.

Johns Hopkins patient information

Last revised: December 8, 2012
by Brenda A. Kuper, M.D.

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