Why and can you survive without your small intestine?

Answer 1

The small intestine absorbs most of the food you eat, as your food is passed 6m round and round its tubes.

If your small intestine was removed, and your stomach was rejoined to your large intestine, you wouldn't get half the nutrients from your food, and so you'd be malnourished.

The worst part is, the rest would have to come out of your body, and it would be all undigested and probably larger than your usual excretions.

But yes, you would survive but not too well.

Here's My Story:

PROLOGUE:

I am sharing my experiences with this severe condition - Short Bowel Syndrome for the benefit of all patients suffering from this critical disease wherein chances of survival are slim - to put it mildly.

I myself read the experiences of a 57 year old gentleman when I first suffered this horrendous fate. Over the year I have derived lots of strength whenever I have felt low and hopeless - just by re-reading the old gentleman's experiences. (This article is available easily over the internet.)

SBS is a serious condition and the best treatment - even beyond medicines - is remaining positive. Don't leave HOPE. Don't give up just yet. If my experience gives you even an ounce of a chance at survival, i will be satisfied.

THE ONSET:

My life of 27 years and my happily married life of 10 months was going on at full pace and totally immersed in the 'rat race' that is so passionately followed by most of the software profesionals in India.

It was 31st of December, 2009 (new year's eve 2010) and more importantly an extended weekend that allowed us(me and my wife) to pay a visit to my parents just 60kms from my workplace. We started an hour early from office fearing the dreaded year-end cum week-end traffic in New Delhi. Midway to my parents' place, about 2 hours later, a slight pain started in my lower back just above the hip. Nothing un-usual, I thought, Back pain is common to most of 'my kind' specially if you also drive 2 hours at a streach. We reached home, the pain stayed. Through the next 4-5 hours, I tried walking, every posture resting on bed, anything and everything possible. The pain still stayed. Worse, it got more intense and sharper.

I ate very little, vomitted twice and felt like passing stool but just couldn't. I felt constipated. I could pass urine though. At around 11:00 pm observing my antics for long, my wife got serious. Being one of those who pride themselves in withstanding pain, I tried to persuade her that it was nothing more than some gas trapped in my bowels. Half an hour later, when I couldn't bear it anymore, requested my dad to take me to the nearest hospital.

It was nearing the new year and the emergency staff in the nearest hospital injected me with a pain-killer. Relief was immediate. Before I knew, we were on our way back home - relieved and happy that we were out of hospital just before onset of the new year! Little did we expect the horrible chain of events taht folowed.

THE DIAGNOSIS:

The next day passed uneventful until evening. The pain started again - same time - same place. It followed the same graph of time v/s intensity as the day before. My folks got serious this time. We were back in hospital and I was administered the same pain-killer as yesterday but this time I got admitted for further check-ups. The effect of the pain killer didn't last long and soon I was writhing with pain once again. The intensity kept on increasing to the point when it became in-tolerable. I asked the emergency staff to give me a stronger dose of pain-killer. They consulted the gastroentrologist on phone who advised the staff NOT to administer any more pain-killer as it might 'hide' the cause of pain when the doctor visited me next morning. This aggrevated my pain and my anger on just about anyone and everyone. I was clutching my waist with both hands. I was shouting. I was abusing. Just mere remembering that moment still sends a chill down my spine. Only I know how long that night was...

Next morning, doctors and specialists suggested that it was either my pancreas that had ruptured or there is a stone in my gall bladder or the intestine is bent at a place and is blocked. The possibility of intestine bending was rare but indicated by the fact that I had not passed any stool since 2 days. They decided to do a barium water x-ray to see where the blockade is. I drank the bottle of barium water but as my stomach was already full, vomitted out most of it. Barium x-ray gave no results. Another day passed. Next day a tube was sent through my nose to my stomach to empty it out. I drank another bottle of barium water and an x-ray was done. The results were inconclusive for the doctors. They had never seen such a case before and just couldn't find a possible cause of the problem. I passed out. My BP started dropping. The doctors became panicky and explained to my dad that 'exploratory surgery' was their only option now and that my situation is critical with slim chances of survival.

My family was shocked as if the rug had been pulled from beneath their feet. Still my dad remained strong and stable. A decision had to be made - to take me to a better hospital 25 kms from here at 11:00 pm in dense fog with a visibility of barely 2 meters and risk precious time or to go ahead with the surgery here. He chose the latter.

THE SURGERY:

Doctors operated upon my lower abdomen not knowing what to expect. What they found was horrifying - not because they found the entire length of my 20 ft long - small intestine black and blue and dead but because it meant that survival will be a miracle. They cut the dead intestine and joined the remaining 20 cm of intestine at the beginning to the start of the long intestine. What actually happened was that the blood vessel that supplied blood to the intestine developed a clot and the intestine choked for the want of fresh blood. Scientifically, the condition is called Short Bowel Syndrome caused due to superior mesentric vein thrombosis. How it happened is still a mystery.

THE DAY AFTER:

I woke up in the ICU feeling a little heavy on my stomach. Not knowing anything that have been mentioned in the few paragraphs above, I felt upbeat and in no pain at all. I just felt thirsty but was refused water by the doctors 'for a day or two'. During the visiting hours, my dad and my wife came to visit me in the ICU. They looked happy and I shared my happiness of getting rid of the pain with them. I didn't knew that their happy faces were just a mask hiding their extreme concern and despair at the slim chances that I had. I was shifted to the private ward a few days later and was allowed to drink sips of water and a liquid diet.

Slowly I came to know about my condition but I still remained upbeat as the doctors re-assured me that slowly the body will adapt and that the large intestine will take ove the functionality of the small intestine. I suffered from frequent bouts of stomach cramps, lots of stomach gas, frequent diarrea, extreme thirst, loss of appetite and extreme loss of weight(more than 1/3rd of my body weight was lost). I was administered intravenous TPN - total parenteral nutrition - a costly substitute for daily calorie and mineral requirements for people with disfunctional absorptive mechanisms. Few days later I developed high fever due to intravenous feeding and my hands were swollen and painful due to the viscous TPN. I decided not to continue with it any more and give my body a chance.

I rejoined office in an attempt to bring normalcy to my life. Though I felt exhausted I was able to continue for 1-2 weeks. My body weight kept reducing as my body was unable to absorb sufficient calories from daily food and it 'fed' on the stored fat that had accumulated over the years. Soon at a mere 43 Kg, we realized that I cannot continue in this fashion and something had to be done to arrest the rapid loss of weight. The only solution was to fit a catheter in my centeral venous system so that the viscous TPN can be administered through it to maintain my body weight. The device was surgically fitted after 7 months of the initial surgery and TPN was administered daily in bags of 1L daily.

My body weight started to increase and it reached 54 Kg in about 2 months. I felt more & more energetic and was ready to re-join office again. The plan was to administer TPN daily after office hours and remove it in the morning.

THE INFECTION:

The plan worked for a mere 4 days. On the 5th day, I developed cold and flu and decided to skip office for the day and recover over the weekend. When we started a new bag of TPN that evening, within 20 mins I began shivering. I was shivering so hard that it woke up my wife besides me. We checked the temperature and it was 107 degrees F. All of us were frightened and I collapsed and passed out on my way to the washroom. I was rushed to a hospital in an ambulance and given very strong antibiotic to control the infection. My blood reports suggested that my platelets have fallen below 30000 and it usually suggested a viral infection - dengue probably. After a week in the hospital, the fever settled and I was discharged.

Back at home, I started the TPN again. But alas, within half an hour, the fever shot up again to 104 degrees F. I was back in hospital again. This time, on hearing the turn of events specially that both the times, the fever had shot up within minutes of administering TPN. This meant that the catheter device had caught a bacterial infection and the best way to tackle the problem was to remove it. Removed it was.

The catheter device always has this drawback - it is full of risk as it is a permanent opening for foreign substances directly to your blood stream. A bacteria had probably sneaked through the opening in one of the several instances the port was opened to administer TPN. Such infections is called 'septicemia' in technical terms.

The SECOND INNINGS:

Exactly a year after the initial surgery, on the 1st of January, 2011, a new catheter device was fitted again. A month later I re-re-re-joined office. Two months have elapsed since then, I have been able to perform routine tasks in office and home - walk, talk, eat out at times, drive and just about everything.

Now I have restricted the use of TPN to week-ends(friday evening to monday morning) - taking in a total of 5 Litres of TPN in a week. This has been done to reduce the risk of infection as the opening to the catheter is a needle which is removed as soon as the weekly TPN is finished on Monday mornings. Secondly, a lot of extra care is taken not to infect the site - handwashes, gloves, sterile instruments, masks, etc.

THE FUTURE:

At times we have thought about an intestine transplant - a surgery so rare that it is still to be performed in India. Yes, they have carried it out some times in the US but the survival rate is too low for the risk. The doctors at Appolo, New Delhi have advised to take the transplant route only as a last option. Having said that, the transplant is a very expensive and somewhat out-of-reach for an oridinary middle-class family in India.

Nobody knows what the future has in store for me. But I am hopeful that one day, I will be able to live a near-to-normal life. I hope that within another year or so, my body will adapt to a degree that TPN will not be needed any more.

And then, for sure, I will do things that I have so ignored when I was well and that I so longed to do in the past year - the simple joys of life, spending quality time with family - my wife - my parents, visiting places, trying out new things, meeting people...

There is one thing that I would NOT be a part of ever again - the maddening rat race.

THINGS THAT WORKED FOR ME:

- Less fluids because fluids push the food out of your system. But be careful, enough fluids should be taken as required by the body else there is a risk of dehydration.

- Small & frequent diets.

- Lots of carbs in diet.

- No salads please!

- Family support - crucial for survival

- Oil Massage from my Mom and my Dad's strength

- Just one touch of my loving wife

THINGS THAT DIDN'T WORK FOR ME:

- Glutamine - Though prescribed by all doctors and internet sites worldwide, i never seemed to benefit from this.

- Special diet - briefly for a period of 2 months, I was put on a special diet consisting of raw egg, soya, curd, etc. The taste was bad and with no visible signs of improvement I put it off.

- Negativity - At most of the times i felt that I had no chances of survival at all. The fear of death itself is enough to kill a man.

MEDICATION:

- Pancreatin - enzymes to act on the food for faster decomposition and hance absorption

- Loperamide - to slow the movement of the large intestine so that the food remains in the body longer and hence a chance for more absorption

- An acid binder

- Vitamin B-complex injectibles - once a month

- Weekly calcium supplements

- A tablet daily to reduce the clotting tendency of my blood.