The condition that develops after resection of the small intestine and is characterized by diarrhea, steatorrhea, malabsorption of nutrients, is commonly called short (or short) bowel syndrome..

There are two types of post-resection enteral insufficiency.

The first of them is the proximal resection syndrome, which occurs when the proximal intestine is removed.. When less than 50% of the small intestine is removed, it proceeds subclinically, but a larger volume of resection leads to increasing steatorrhea, iron and folic acid deficiency.

The second type is distal resection syndrome associated with the removal of the ileum.. In this case, preservation of the ileocecal valve is important.. If it is present after extensive resections, the time for passage of food masses through the intestine can increase by 2 times.

Due to adaptive processes in the residual intestine (increase in its diameter, villi height, crypt depth, cell proliferation, acceleration of the rhythm of epithelium renewal, increase in nutrient transport and activity of intestinal enzymes), the absorption capacity of the intestine increases almost 4 times.

In addition, the presence of an ileocecal valve prevents bacterial colonization of the remaining small intestine, leading to a further increase in malabsorption, since nutrients, especially vitamin B12, the absorption of which is already impaired during resection of the distal segments of the intestine, become a substrate for bacterial metabolism before they are absorbed by the intestinal mucosa..

If in patients with a favorable postoperative course, a rapid recovery of bowel function, the transition to full natural nutrition and oral symptomatic treatment should be carried out gradually, but reasonably quickly (see. above), then after extensive bowel resections, tactical haste can cause significant harm.

The transition from total parenteral to natural nutrition should take place over a fairly long stage of partial parenteral nutrition, sometimes extended over several months..

Gradually, over many months (the duration is determined purely individually), the patient's nutrition should approach a full-fledged natural. The sequential appointment of surgical diets for patients with bowel resection has already been discussed in detail above.. However, this process of dietary adaptation should be \; the introduction of new products in diets of therapeutic nutrition should strictly depend on the individual tolerance of patients.

The protein-energy deficiency of the considered diets in relation to the physiological needs of the body should be covered by parenteral nutrition and enteral mixtures.

Moreover, taking into account the pathogenetic features of the development of postoperative pathology, according to the reasonable opinion of a number of authors, after switching to a complete natural diet, patients with a short intestine are recommended a diet with a high content of protein, carbohydrates and a moderate amount of fat, which should be supplemented with triglycerides with an average carbon chain length, multivitamins.

Dynamic laboratory monitoring of oxalate levels allows, when the first signs of hyperoxaluria appear, to limit the intake of foods containing an increased amount of oxalates (sorrel, spinach, parsley, potatoes, chocolate).

After 2 years after the operation, when the maximum adaptation of the gastrointestinal tract, and primarily the intestines, is achieved, various clinical variants of the course of the disease can be observed, which require appropriate individual approaches to the nutrition of patients:.

a) natural normal or close to normal nutrition;

b) natural nutrition using individually selected depolymerized nutrients;

c) natural nutrition with partial parenteral support;

d) total parenteral nutrition.

Baranovsky medbe. en.