Short bowel syndrome

The small intestine absorbs much of the nutrients found in foods we eat. When two-thirds or more of the small intestine is missing, the body may not absorb enough food to stay healthy and maintain your weight.

Some infants are born missing part or much of their small intestine.

More often, short bowel syndrome occurs because much of the small intestine is removed during surgery. This type of surgery may be necessary for the following conditions:

• Gunshots or other abdominal trauma that damages the intestines.
• Severe Crohn disease.
• Death of intestinal tissue in premature or sick babies.
• Reduced blood flow to the small intestine due to blood clots or narrowed arteries.
• Complications from bariatric surgery.
• Radiation enteritis.

Symptoms may include:

• Diarrhea
• Fatigue
• Pale, greasy stools
• Swelling (edema), especially of the legs
• Very foul-smelling stools
• Weight loss
• Dehydration

The following tests may be done:

• Blood chemistry tests (such as albumin level)
• Complete blood count (CBC)
• Fecal fat test
• Small intestine x-ray
• Vitamin levels in the blood

Treatment is aimed at relieving symptoms and ensuring the body receives enough hydration and nutrients.

A high-calorie diet that supplies:

• Key vitamins and minerals, such as iron, folic acid, and vitamin B12
• Enough carbohydrates, proteins, and fats

If needed, injections of some vitamins and minerals or special growth factors will be given.

Medicines to slow down the normal movement of the intestine can be tried. This may allow food to remain in the intestine longer. This could include anti-diarrheal medicines and bile acid sequestrants if there is remaining colon. Medicines to lower the amount of stomach acid may also be needed.

If the body is not able to absorb enough nutrients, total parenteral nutrition (TPN) is tried. It will help you or your child get nutrition from a special formula through a vein in the body. Your health care provider will select the right amount of calories and TPN solution. Sometimes, you can also eat and drink while getting nutrition from TPN.

Small bowel transplantation is an option in some cases.

A medicine called teduglutide is available to help the bowel adjust to the shorted intestine. It helps in specific situations. Ask your provider if it might help you.

The condition may improve over time if it is due to surgery. Nutrient absorption may slowly get better.

Complications may include:

• Bacterial overgrowth in the small intestine
• Nervous system problems caused by a lack of vitamin B12 (this problem can be treated with vitamin B12 injections.)
• Too much acid in the blood (metabolic acidosis due to diarrhea)
• Gallstones
• Kidney stones
• Dehydration
• Malnutrition
• Weakened bones (osteomalacia)
• Weight loss
• Intestinal failure associated liver disease
• D-lactic acidosis

Contact your provider if you develop symptoms of short bowel syndrome, especially after you have had bowel surgery.

Small intestine insufficiency; Short gut syndrome; Necrotizing enterocolitis - short bowel

Buchman AL. Short bowel syndrome. In: Chung RT, Rubin DT, Wilcox CM, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 12th ed. Philadelphia, PA: Elsevier; 2026:chap 108.

Semrad CE. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 126.

Venick RS. Short bowel syndrome. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. 7th ed. Philadelphia, PA: Elsevier; 2026:chap 35.

Updated by: Todd Eisner, MD, Private practice specializing in Gastroenterology in Boca Raton and Delray Beach, Florida at Gastroenterology Consultants of Boca Raton. Affiliate Assistant Professor, Florida Atlantic University School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.