Background

Whether in the setting of trauma, metabolic surgery or emergency surgery to the gastrointestinal tract, short bowel syndrome in the setting of extensive small bowel resection is a dreaded complication that can cause a multitude of adverse effects which vary depending on the length and type of tissue removed. The loss of absorptive capacity often results in electrolyte abnormalities, nutrient deficiencies, chronic diarrhea, and extra-intestinal sequelae. We report the unique and interesting case of a 47-year-old female patient who presented to the emergency department complaining of abdominal pain. Her physical exam was concerning for generalized peritonitis and her lab studies revealed an elevated leukocyte count and normal lactic acid levels. Upon CT evaluation of the abdomen, the patient was found to have multiple thrombi along the course of the SMA causing proximal partial occlusion and distal complete occlusion. Subsequently, 230cm of the small bowel was resected starting 5 cm from the ligament of Treitz as well as an extended right hemicolectomy. The remaining healthy jejunal tissue was used to create a jejunocolic anastomosis. Despite the high morbidity and mortality associated with acute mesenteric ischemia, the patient recovered well in the postoperative period, requiring minimal electrolyte supplementation despite her marked tissue loss. Furthermore, she was producing only four bowel movements per day, a highly unexpected finding considering the significant small bowel and large bowel resection.