American Journal of Clinical Nutrition, Vol 17, 64-72, Copyright © 1965 by The American Society for Clinical Nutrition, Inc.

Malabsorption Following Massive Intestinal Resection

¹ From the Division of Experimental Surgery and Physiology, and the Andre and Bella Meyer Physiology Laboratory, Sloan-Kettering Institute for Cancer Research; and the Department of Medicine, Memorial and James Ewing Hospitals, New York, New York

A fifty-seven year old woman underwent resection of the right hemicolon, the ileum and all but 90 cm. of the jejunum in 1954. Steatorrhea developed subsequently. Serial studies in the ensuing ten years showed fat absorption to be fairly constant. While the patient was able to increase absolute fat absorption upon fat loading, this caused bloating and diarrhea even though the per cent fat absorption did not change markedly. Nitrogen absorption was impaired, but the patient remained in positive nitrogen balance. There seemed to have been some improvement in nitrogen absorption, with time, after surgery.

Three to five years after surgery megaloblastic anemia secondary to vitamin B₁₂ deficiency developed. Vitamin B₁₂ in physiologic doses is absorbed in the ileum, which was removed surgically in our patient. Patients with extensive ileal resection require permanent parenteral administration of vitamin B₁₂ The patient absorbed other water-soluble substances normally.

The need for supplementary calcium, magnesium or vitamin D was never established in this patient, although they may be required by some patients after massive intestinal resection, especially if the fat intake is maintained at a level resulting in frequent loose movements.

Consequently, restriction of fat intake to 30 to 50 gm. daily, and parenteral administration of vitamin B₁₂ seem to constitute the only nutritional therapy necessary for patients who have no ileum. Patients who have no jejunum, but have an intact ileum, do not require any specific dietary therapy. If the ileum is completely absent, the critical minimal amount of jejunum necessary for satisfactory absorption of water-soluble nutrients would appear to be 1 to 4 feet. These simple rules provide a clinical approach to the management of patients who have had extensive removal of intestine.