ONE OF the most intriguing and challenging problems the surgeon encounters today is the management of the patient in whom a massive small-bowel resection has been carried out in the treatment of a variety of pathologic entities. When only 90 cm or less of small intestine remain in continuity various problems may arise. These include diarrhea, steatorrhea, fluid and electrolyte imbalance, hypocalcemia, hypomagnesemia, decreased absorption of fat and fat soluble vitamins, hypoglycemia, anemia, negative nitrogen balance, hypersecretion, and weight loss. Cachexia readily follows.1-10
A variety of surgical procedures including the use of reversed segments of small bowel and small-bowel loops have been proposed to minimize the fluid, electrolyte and other losses.11-14 Disenchantment with the long-term results of these procedures15 has prompted us to reassess the role of dietary management, combined with vagotomy and pyloroplasty which may decrease both acid secretion and peristaltic activity and thus improve absorption.
Leonard AS, Levine AS, Wittner R, Buchwald H, Varco RL. Massive Small-Bowel Resections: Operative and Dietary Management. Arch Surg. 1967;95(3):429–435. doi:10.1001/archsurg.1967.01330150105014
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