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Detailed information of STAGNANT LOOP SYNDROME
STAGNANT LOOP SYNDROME
DEFINITION:
A malabsorptive disorder characterized by incomplete bowel
obstruction resulting in small bowel bacterial overgrowth.
EPIDEMIOLOGY:
- incidence: ?
- age of onset:
- risk factors:
- incomplete bowel obstruction
- congenital causes
- acquired causes
- postoperative adhesions, longstanding Crohn's
- Gastrointestinal motility disorders
PATHOGENESIS:
- incomplete bowel obstruction impairs intestinal motility or
alters the normal intestinal mucosal barrier so that bacteria
colonize the upper small bowel. There, the bacteria:
- deconjugate bile salts -> fat malabsorption -> steatorrhea
- bind Vitamin B12 -> megaloblastic anemia
- damage brush border -> decrease disaccharidase activity
CLINICAL FEATURES:
- chronic incomplete bowel obstruction
- distension
- abdominal pain
- nausea & vomiting
- steatorrhea
- diarrhea
INVESTIGATIONS:
- see "Malabsorptive Disorders"
2. Tests for Bacterial Overgrowth
- load the body with vitamin B12
- administer *vitamin B12 + intrinsic factor + Antibiotic
- if > 95% *vitamin B12 in 24 hour urine -> bacterial
overgrowth
2. Breath Hydrogen Excretion
- hydrogen concentration in expired air after an oral dose
of sugar (2g/kg body weight to a maximum of 50g) and abnormal
if >20 ppm during the first 2 hours
MANAGEMENT:
- Septra, Clindamycin (broad spectrum with anaerobic coverage)
2. Surgery
- correct incomplete bowel obstruction
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Pediatric Database - STAGNANT LOOP SYNDROME
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