[Verse 1]
Short bowel syndrome — gut too short to cope
Less than two hundred centimetres, barely enough rope
Jejunostomy end? You'll lose fluid by the litre
Colon in continuity? The prognosis gets sweeter
Ileum matters — B12 and bile salts absorb here
Lose the ileocaecal valve and bacterial overgrowth draws near
Three phases: acute, adaptation, then the steady state
Early aggressive replacement — fluids, lytes — can't wait
[Chorus]
FRIEND blocks closure — Foreign body, Radiation
Infection, Epithelialisation, Neoplasm, Distal obstruction
SNAP before you cut — Sepsis first, then feed the patient
Anatomy defined, then Plan with precision and patience
STEP and Bianchi, taper and lengthen the gut
Transplant's the final card when every other door is shut
[Verse 2]
Medical management — layer it carefully
PPI to cut the acid hypersecretion, stat
Loperamide, codeine — slow that transit down
Teduglutide mimics GLP-2, rebuilds the mucosal crown
Stimulates villous growth, reduces parenteral need
TPN keeps them alive but watch for what it breeds
Line sepsis lurking — fever, rigors, exit site
IFALD — liver's failing, bilirubin climbing overnight
[Chorus]
FRIEND blocks closure — Foreign body, Radiation
Infection, Epithelialisation, Neoplasm, Distal obstruction
SNAP before you cut — Sepsis first, then feed the patient
Anatomy defined, then Plan with precision and patience
STEP and Bianchi, taper and lengthen the gut
Transplant's the final card when every other door is shut
[Verse 3]
Enterocutaneous fistula — gut breaching the skin
SNAP is your framework before you wade in
Control the sepsis, drain the collections down
Optimise nutrition, TPN if the gut's not sound
Define the anatomy — contrast, fistulograms, CT scan
Wait for inflammation to cool before you plan
Spontaneous closure needs six to eight weeks at least
High output, hostile abdomen — surgical beast
[Bridge]
Restoration of continuity — reconnect what's been split
Serial transverse enteroplasty — STEP — taper and lengthen it
Bianchi splits the mesentery, doubles the tube
Isolated small bowel, multivisceral — pick your transplant groove
Reserved for irreversible failure, IFALD that won't reverse
TPN dependency — intestinal transplant for the worst
[Verse 4]
Prognostic anatomy decides the trajectory
Jejunum-colon anastomosis — colon earns its salary
Absorbs fluid, ferments fibre, salvages what remains
End jejunostomy — sodium below one-thirty, constant drains
Hypermagnesiuria, D-lactic acidosis in the brew
Oxalate nephropathy when the colon's still in view
Know your remnant, know your patient, map the risk
Adaptation takes two years — don't dismiss
[Chorus]
FRIEND blocks closure — Foreign body, Radiation
Infection, Epithelialisation, Neoplasm, Distal obstruction
SNAP before you cut — Sepsis first, then feed the patient
Anatomy defined, then Plan with precision and patience
STEP and Bianchi, taper and lengthen the gut
Transplant's the final card when every other door is shut