Prolonged Survival With Paired Reversed Segment After Massive Intestinal Resection

Abstract

Introduction RESECTION of 50% of the total small bowel is well tolerated in children as well as adults.^2,3 There are also reports of survivals following 70%-80% bowel resection with no apparent ill effects. However, some acute abdominal catastrophes, such as mesenteric vascular occlusion in the elderly or volvulus in younger patients, may necessitate resection of up to 90% of the small bowel. The immediate morbidity and mortality following massive intestinal resection can be minimized by the prudent use of antibiotics and by adequate colloid and blood replacement. Unfortunately, the surviving patient usually experiences persistent diarrhea, weight loss, and inanition progressing to death. Surgical approaches toward slowing intestinal transit and increasing absorption have included vagotomy and pyloroplasty,⁴ interposition of an antiperistaltic gastric tube,⁵ construction of recirculating small bowel loops,⁸ and reversal of a segment of the remaining small bowel.⁷ We have now evaluated the effect