Pediatric Short Bowel Syndrome Workup

Updated: May 23, 2019
  • Author: Carmen Cuffari, MD; Chief Editor: Jatinder Bhatia, MBBS, FAAP  more...
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Workup

Laboratory Studies

Perform standard hematologic and biochemical studies in all children with short bowel syndrome (SBS). Each institution follows its own specific guideline. The following list is not intended to represent an exhaustive list of laboratory evaluations:

  • Electrolytes, BUN, creatinine, calcium, magnesium, phosphorous - Biweekly in both the initial phase and the late period or at the time of presentation for instability

  • Comprehensive panel, CBC count, triglycerides, cholesterol - Weekly in both the initial phase and the late period or at the time of presentation for instability

  • Folate, vitamin B-12, vitamin E, copper, zinc, selenium - Monthly in both the initial phase and the late period or at the time of presentation for instability

  • Carnitine

Microbiology

  • Any suspicion of sepsis necessitates blood cultures. Children with short bowel syndrome are susceptible to intestinal bacterial translocation, with the central line as the most likely source of seeding. They are also susceptible to translocation of skin flora such as Staphylococcus species.

  • Obtain blood cultures from both the central and peripheral sites.

  • Consider opportunistic infections, including fungal infections, in the differential diagnosis of a child presenting with sepsis. Obtain a urinalysis and blood culture in these children specifically to search for fungal infection.

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Imaging Studies

Imaging studies are needed to assess for potential complications, including those outlined below

Infection

  • Abdominal ultrasonography to search for fungal balls in the kidney

  • Computed tomography (CT) scanning of the abdomen to identify sepsis

  • Ultrasonography of Broviac tip

Bowel obstruction

  • Plain radiography of the abdomen (see image below)

    Small-bowel obstruction caused by intussusception Small-bowel obstruction caused by intussusception in a 5-month-old patient is visible on plain radiograph.
  • Barium imaging of the bowel

Liver disease

  • Abdominal ultrasonography to study the liver, biliary tract, and spleen, as well as assess for the presence of ascites

  • Abdominal ultrasonography with Doppler to assess portal flow

Potential liver or bowel transplant

  • Volumetric CT scanning of the liver

  • Possible angiography

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Procedures

Children with short bowel syndrome may require laboratory procedures, including the following:

  • Upper endoscopy to assess for peptic ulcer disease and possible signs of liver disease (eg, esophageal varices, hypertensive gastropathy)

  • Liver biopsy to evaluate the patient for signs of total parenteral nutrition (TPN)-related liver disease (This is rarely performed unless the presentation is unusual.)

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