Treatment and diet therapy
Ideally, treatment already begins before surgery by compensating any existing malnutrition or nutritional definiencies by tube feeding or nutritional drinks. The diet therapy approach applied after surgery again depends on:
- Length of the small intestine remaining
- Adaptability of the remaining intestine
- Whether or not the ileum or the jejunum were removed
- Whether or not the ileocecal valve was removed
- Whether or not (in addition) a part or the whole large intestine was removed
Immediately tailored to the patient?s needs:
- Generally, oral food intake should be initiated immediately after the operation in order to make maximum use of the remaining absorption capacity and to stimulate the adjustment of the remaining intestine.
Adaptation is possible up to a 50% removal of the small intestine.
- After the removal of the jejunum, the absorption of nutrients is usually taken over well by the ileum.
If the level of adjustment is not sufficient or the length of the remaining bowel is insufficient, nutrient supply (especially water, minerals, trace elements) must be combined with parenteral nutrition. Training the villi of the small intestine and temporary nutritional support via a special vein catheter are often required.
- Was the small intestine removed while the colon is still intact? Hardly any diarrhea with intact ileum (because of bile acid reabsorption). An intact colon turns unused carbohydrates into short-chain fatty acids with the help of bacteria, and then takes them up (energy source).
- If the remaining bowel length is 50-70cm, exclusive oral food intake is still possible, however a special training of the small intestine and a supportive infusion therapy are normally required to ensure sufficient and adequate nutrition.
- If the ileum is not intact or has been removed, bile acid and salts are transferred into the colon. These inhibit water reabsorption in the colon and thus lead to bilious diarrhea. If more than 100cm of the ileum were removed, fatty stools may also occur quite frequently. These are whitish and of a very bad stench and they are a major burden for the patient.
- If both the small intestine and the colon were removed: Further major water and electrolyte loss and severe diarrhea. Difficult to treat.
- If the remaining bowel length is 110-115cm, exclusive oral food intake is still possible.
- If both the colon and the ileocecal valve were removed: Further major water and electrolyte loss and severe diarrhea.
- If the remaining bowel length is 30-50cm, then parenteral nutrition must be applied on a long-term basis.