Concerns After 230cm Small Bowel Resection: Managing Diarrhea and Weight Loss

Q: Concerns After 230cm Small Bowel Resection: Managing Diarrhea and Weight Loss

Hello： Regardless of whether it is the large intestine or small intestine, it is common in clinical practice to encounter unformed stools, watery stools, or mushy stools after surgical resection. <br>The small intestine is the primary site for nutrient absorption in the body, and

Concerns after resection of the distal 230 cm of the small intestine due to intestinal volvulus?

I was hospitalized for 10 days after my small intestine resection and was discharged on July 24.
Currently, I experience diarrhea at least four times a day, and my weight has decreased from 59 kg (measured in the hospital) to 57 kg.
I am now at home following a normal diet, including high-protein foods such as meat and eggs in every meal.
The surgeon mentioned that I have a cecal pouch and that there is still 170 cm of small intestine remaining, so I should not develop short bowel syndrome.
However, my weight continues to decline, and the diarrhea has a slight oily consistency.
During my hospitalization, the doctor indicated that this suggests that food is passing through the intestines, so there is no need for concern.

Currently, I have experienced two episodes of abdominal distension without passing gas or having a bowel movement (which I managed to relieve with a stool softener).
The doctor suggested that the distension might be due to consuming too many gas-producing foods.
Regarding the diarrhea, I was told to wait for the compensatory growth of the intestinal villi, which should improve my condition.
However, I am worried that I might have lifelong diarrhea that will not resolve (I have been prescribed IMODIUM 1 tablet daily, but it still leads to diarrhea).

Despite eating regular meals on time and drinking chicken essence and bird's nest daily, while trying to avoid gas-producing foods (like milk, soda, and soy milk), I am puzzled as to why my weight continues to drop.
Could this lead to malnutrition?

Nianqingren, 10~19 year old female. Ask Date: 2016/07/27

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: Regardless of whether it is the large intestine or small intestine, it is common in clinical practice to encounter unformed stools, watery stools, or mushy stools after surgical resection.
The small intestine is the primary site for nutrient absorption in the body, and a shorter small intestine can affect nutrient absorption.
It is recommended to eat small, frequent meals and maintain a balanced diet.
After all, nutrients that cannot be absorbed will be excreted in the stool, which may increase the likelihood of diarrhea.
If you have any questions, it is advisable to discuss them with the surgeon.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun

Reply Date: 2016/07/27

More Info

After undergoing a 230 cm small bowel resection, it is understandable to have concerns about persistent diarrhea and weight loss. The small intestine plays a crucial role in nutrient absorption, and any surgical alteration can significantly impact this function.
Firstly, it’s important to recognize that diarrhea following small bowel surgery is a common occurrence. The small intestine is responsible for absorbing nutrients and water from the food we consume. When a significant portion of it is removed, as in your case, the remaining intestine may struggle to absorb nutrients effectively, leading to loose stools. The fact that your stool is oily suggests that fat malabsorption is occurring, which is often a result of inadequate surface area for absorption due to the resection.

Your current weight loss from 59 kg to 57 kg, despite consuming a diet rich in proteins and avoiding gas-producing foods, indicates that your body may not be absorbing these nutrients adequately. This can lead to nutritional deficiencies over time, which is a valid concern. It’s crucial to monitor your weight and nutritional status closely. You might consider consulting with a dietitian who specializes in post-operative care to help you develop a balanced diet that maximizes nutrient absorption.

The advice from your surgeon about waiting for the intestinal villi to regenerate is valid; however, this process can take time, and the degree of recovery can vary from person to person. It’s also worth noting that while you have a remaining length of 170 cm, the function of the intestine is not solely dependent on length but also on the health of the remaining tissue and its ability to adapt.

Regarding the use of Imodium (loperamide), while it can help reduce the frequency of diarrhea, it is essential to use it cautiously. Overuse can lead to constipation or other gastrointestinal issues. If you find that it is not effective, it may be worth discussing alternative medications or treatments with your healthcare provider.

The episodes of abdominal bloating and the need for stool softeners suggest that your digestive system is still adjusting to the changes. It’s not uncommon for patients to experience fluctuations in bowel habits and discomfort in the months following surgery. Keeping a food diary may help identify any specific triggers that worsen your symptoms.

In summary, while it’s natural to worry about the long-term implications of your surgery, many patients experience improvement over time as their bodies adapt. Regular follow-ups with your healthcare team, including your surgeon and possibly a gastroenterologist, are essential to monitor your condition. They can provide tailored advice and interventions to help manage your symptoms and ensure that you are receiving adequate nutrition. If your symptoms persist or worsen, further evaluation may be necessary to rule out complications such as bowel obstruction or other gastrointestinal disorders.

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