Surgical and Medical Approaches for the 'No Gut Syndrome' Patient

Albert B. Lowenfels, MD


August 30, 2017

What are the best strategies for management of patients who have had total resection of the small bowel? The authors of a study published in Surgery[1] review their experiences treating 13 patients with total small-bowel resection.

Tumors affecting the small-bowel blood supply, thrombosis of the superior mesenteric artery, or trauma were the major reasons for the loss of the small bowel. Anastomosing the duodenum to the colon seemed to provide the best results because it allowed patients to consume some nutrients and liquids by mouth. All patients required daily total parenteral nutrition (TPN). Three quarters of patients were alive after a median follow-up of 20 months.


Of all the gastrointestinal organs, loss of the small bowel is the most devastating, requiring several hours of daily TPN to assure survival. Fortunately, complete loss of the small bowel is rare, with only a few published case reports. This report comprising 13 patients is the largest case series to be published.

Small-bowel transplantation offers the best hope for long-term survival, and three of the 13 patients in the report have already undergone transplantation, with transplantation being planned for several other patients. Care of the patients requires a dedicated staff with experience with nutritional support to maintain patients while being evaluated for small-bowel transplantation.

Follow Medscape Surgery on Twitter for more surgery news: @MedscapeSurgery


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: