Extensive resection of the small bowel, leaving only 2 or 3 feet beyond the ligament of Treitz anastomosed to the transverse colon, can lead to the following metabolic complications:

A. Gastric hyperacidity and hypersecretion.

B. Hyperoxaluria

D. Fat-soluble vitamin deficiency.

DISCUSSION: Once the stress of the surgical procedure is over, there is no further hypermetabolic response, nor does there appear to be any reduced energy expenditure from loss of the metabolically active small bowel. Energy needs are unaltered. Gastric secretion and hyperacidity are directly related to the extent of small bowel resection and is due in part to increased concentrations of gastrin in the serum. H 2 blockers are effective in reducing acidity and volume of gastric secretions. Hyperoxaluria develops owing to binding of calcium to fat in the diet with steatorrhea, leaving less to bind with dietary oxalate. The soluble oxalate is absorbed by the colon and excreted in the urine. If oxalate is excessive, oxalate kidney stones can form. With fat malabsorption due to bile salt depletion and rapid intestinal transit, absorption of the fat-soluble vitamins A, E, K, and D is reduced. Even with oral supplementation, deficiencies can develop.