The nutritional therapeutic options after intestinal surgery depend on the time interval between the operation and the operation as well as on the extent and location of the operation. Up to a removal of 50% of the small intestine, the remaining intestine can usually ensure the digestion of nutrients after some time of adjustment. The more small bowel tissue is removed, the more likely it is that there will be a deficiency in the supply of nutrients, energy and water.
If 75% of the small intestine is missing, this deficiency is serious. With a residual length of 30 to 50 cm, parenteral nutrition (with the help of an infusion) must be provided in the long term. However, it is also decisive which part of the small intestine was removed.
For example, in the terminal part of the small intestine (terminal ileum) the bile salts are reabsorbed. If a part is missing, bile salts are transferred to the large intestine, where they inhibit the reabsorption of water through the intestinal wall and lead to diarrhea (chologic diarrhea). In addition, bile salts are excreted more frequently and the resulting deficiency disturbs the digestion of fat, resulting in fatty stools and a lack of energy.
In addition, increased fatty acids remain in the intestinal lumen and can combine with calcium to form insoluble lime soaps. Calcium also combines with oxalic acid from food to form water-insoluble calcium oxalate. If less calcium is available more Oxalsäure is taken up by the intestine wall and it exists the danger of the stone formation (Oxalatsteine) in the discharging urinary tract.
In addition an increased bile salt concentration probably increases the absorption of oxalic acid. Foods rich in oxalic acid should therefore be avoided (chard, rhubarb, spinach, cocoa, beetroot, parsley). A sufficient fluid intake of 1.5 to 2 liters per day also helps to prevent kidney stones.
If necessary, the usual fats are replaced up to 75% by MCT fats. This can contribute to a significant improvement in the nutritional status. If the lower part of the small intestine has been removed, vitamin B12 must be supplied via medication.
Since the digestion of fat is often disturbed, it is also important to ensure a sufficient supply of fat-soluble vitamins. A fluid intake during the meal accelerates the passage of the food pulp through the stomach and the small intestine and thus worsens the absorption of nutrients. To avoid this it is recommended to drink 1 hour after food intake.
