Massive resection of the small bowel

A report is presented on patients (no. = 43. 64 +/- 9 years, 30 men and 13 women) subjected to a massive small bowel resection (69 +/- 25 cm intestine left). The most usual indication was thromboembolism of the arteria mesenterica superioris, but there were also patients who had had intestinal by-pass, occlusion, trauma, tumor and invagination. The preoperative diagnosis was based on peritonitis, increasing abdominal symptoms, paralytic ileus, shock and fever. Fluid and electrolyte treatment, postoperative intensive care, intestinal decompression, parenteral nutrition and antibiotics were also employed. Postoperatively there was a significant decrease in serum protein (SP) (63 +/- 11 vs. 43 +/- 9 g/l) and blood hemoglobin (150 +/- 10 vs. 106 +/- 8 g/l) concentrations (Hb) and hematocrit (CHCT) (0.44 +/- 0.11 vs. 0.31 +/- 0.10). Also the number of patients with subnormal SP and Hb increased from five to nineteen and from fourteen to thirty-two, respectively. The operative mortality (within 30 days) was 60 percent (26/43). Those who survived were younger (59 +/- 8 vs. 67 +/- 9 years) and had higher SP (87 +/- 12 vs. 47 +/- 11 g/l), blood leukocyte count (22 +/- 6 vs. 14 +/- 5 X 10(9] and lower peroperative blood loss (291 +/- 43 vs. 448 +/- 67) than those who died. During the one to 14 year follow-up time nine (21% of all patients and 59% of those who were discharged) were still alive. Thus the patients subjected to a massive small bowel resection are old, have atherosclerotic cardiovascular diseases and preoperatively have peritonitis or severe abdominal complaints and an impaired nutritional state and fluid balance.