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
Bowel perforation
Gastroparesis
Diabetic ketoacidosis
Inflammatory bowel disease
Mesenteric ischemia
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

External Links

References

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

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