Short-bowel syndrome. Medical aspects and prospects of intestinal transplantation.

Major intestinal resection may result in diarrhea and malabsorption, a clinical entity known as the short-bowel syndrome. Nutritional prognosis after a wide intestinal resection depends on the extent of resection, the nature of the intestinal segment removed (ileum or jejunum), the function and the adaptative capacity of the remaining intestine, and the preservation of the colon and the ileocecal valve. Adequate management of this dreadful syndrome requires a multidisciplinary effort between various medical specialties: general and pediatric surgery, intensive care unit, nutrition, psychology, pediatric and adult gastroenterology. Intestinal transplantation is the only chance for a real cure in patients who depend on total parenteral nutrition. Although results of small bowel transplantation have dramatically improved over the last few years, it remains a challenging surgical and immunologic enterprise. Severe rejection and infection are the major obstacles.