Malabsorption after Small Bowel Resection

Malabsorption after small bowel resection ( ICD-10-GM K91.2: Malabsorption after surgery, not elsewhere classified) is a common sequela of this operation.

Small bowel resection Synonym: resection of the terminal ileum) is a surgical procedure for partial removal of the small bowel. It is called a massive resection of the small intestine when more than 75% of the organ is removed.

After removal, the resection margins are anastomosed (joined). If more than three meters of small intestine is removed, malabsorption symptoms (short bowel syndrome) usually occur. Malabsorption means that the absorption of previously already broken down (predigested) food components through the intestinal wall into the lymph or bloodstream (enteric absorption) is reduced. The extent of symptoms depends on the following factors:

  • The length and location of the portion of the small intestine that has been removed
  • Presence or absence of the ileocecal valve (valve-like flap between the small and large intestines; serves as a protection against reflux and as a bacterial barrier)
  • Functionality of the remaining small intestine and the remaining digestive organs (stomach, pancreas (pancreas) and liver).
  • Adaptation processes in the remaining small intestine.

Pronounced short bowel syndromes are rare. The incidence (frequency of new cases) is about 1-2 diseases per 1,000,000 inhabitants per year (in Germany). The most common cause of short bowel syndrome is Crohn’s disease. Despite sparing resection techniques, surgical procedures ultimately lead to malabsorption.

In benign (benign) disease, only the affected area is removed. In malignant (malignant) tumors, however, the lymph nodes of this area are also removed.

Course and prognosis: The performance of small bowel resections is much more critical in children than in adults, because they tolerate surgical removal more poorly. Relative to dietary energy intake and energy requirements, young children have a shorter length of small intestine. In addition, the intestinal surface area available for absorption is smaller in children (malnutrition).