Abstract
Fecal mass and electrolyte concentrations from 25 ileectomy and/or colectomy patients on known diets were used to assess those factors most responsible for their diarrhea. In 18 ileectomy patients the severity of diarrhea, expressed as a fecal weight, was a function of both percent of colon and centimeters of ileum removed. Linear regression analysis, however, showed that the extent of missing colon had three times the effect of missing ileum on fecal weight. Patients who lost the ileocecal valve and part of the right colon had more diarrhea than those who lost comparable lengths of ileum but had this area preserved. Fecal ion concentrations seemed independent of diet but were related to fecal weight and the amount of colon and ileum removed. Potassium concentration was strongly dependent on the amount of colon lost, while sodium concentration was more influenced by the length of resected ileum. Chloride was most dependent on fecal weight. As expected, fecal fat correlated strongly with the extent of ileum removed. Regression equations were constructed from the electrolyte data which described and predicted the extent of lost ileum or colon. Our data were also used to separate patients with less than 100 cm of ileum removed from those with more extensive resections. The severity of diarrhea following ileal resection depends primarily on the amount of contiguous colon removed. Varying loss of ileum and colon produced predictable effects on fecal weight and electrolyte composition. Surgeons should preserve the maximum amount of colon possible to reduce the severity of diarrhea in these patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Lack L, Weiner IM:In vitro absorption of bile salts by small intestine of rats and guinea pigs. Am J Physiol 200:313–317, 1961
Hofmann A: Bile acid malabsorption caused by ileal resection. Arch Intern Med 130:597–605, 1972
Soong CS, Thompson JB, Poley JR, Hess DR: Hydroxy fatty acids in human diarrhea. Gastroenterology 63:748–757, 1972
Gazet JC: The surgical significance of the ileo-caecal junction. Ann R Coll Surg Engl 43:19, 1968
Debongnie JC, Phillips SF: Capacity of the human colon to absorb fluid. Gastroenterology 74:698–703, 1978
Cummings JH, James WPT, Wigging HS: Role of the colon in ileal-resection diarrhea. Lancet 1:344–347, 1973
Church CF, Church HN: Food values of portions commonly used. Twelfth Edition, Philadelphia, J.P Lippincott, 1975
Watt BK, Merrill AL: Composition of foods. Agriculture Handbook No. 8. Agriculture Research Service, US Dept of Agriculture 1975
Devroede GJ, Phillips SF, Code CF, Lind JF: Regional differences in rate of sodium and water insorption from the human large intestine. Can J Physiol Pharmacol 49:1023–1029, 1971
Natelson SM: Microtechniques of clinical chemistry. Springfield, Illinois, Charles C Thomas, 1957, pp. 201–202
Collins DP, McCormick PG: Determination of short-chain fatty acids in stool ultrafiltrate and urine. Clin Chem 20: 1173–1180, 1974
Phillips SF: Diarrhea: A current view of the pathophysiology. Gastroenterology 63:495–518, 1972
Fordtran JS: Speculations on the pathogenesis of diarrhea. Fed Proc 76:1403–1414, 1972
Snedecor GE, Cochran WG: Statistical Methods, Sixth Edition. Ames, Iowa, Iowa State University Press, 1967, p 398
Lachenbruch PA: Discriminant Analysis. New York, Hofner Press, 1975, p 25
Lachenbruch PA: Discriminate Analysis. New York, Hofner Press, 1975, p 33
Austad WI, Lack L, Tyor MP: Importance of bile acids and of an intact distal small intestine for fat absorption. Gastroenterology 32:638–646, 1966
Woodbury JF, Kern F: Fecal excretion of bile acids: A new technique for studying bile acid kinetics in patients with ileal resection. J Clin Invest 50:2531–2540, 1971
Hofmann AF, Poley JR: Cholestyramine treatment of diarrhea associated with ileal resection. N Engl J Med 28:397–402, 1969
Phillips SF, Giller J: The contribution of the colon to electrolyte and water conservation in man. J Lab Clin Med 81:733–746, 1973
Williamson RC: Intestinal Adaptation. N Engl J Med 298: 1292–1402, 1444–1450, 1978
Hofmann AF: The syndrome of ileal disease and the broken enterohepatic circulation: Cholerrheic enteropathy. Gastroenterology 52:752–757, 1969
Hofmann AF, Poley JR: Role of bile acid malabsorption in pathogenesis of diarrhea and steatorrhea in patients with ileal resections. Response to cholestyrame or replacement of dietary long chain fatty medium chain triglyceride. Gastroenterology 62:918–934, 1972
Mekhjian JS, Phillips SF, Hofmann AF: Colonic secretion of water and electrolytes induced by bile acids: Perfusion studies in man. J Clin Invest 50:1596–1577, 1971
Andersson H, Isaksson B, Sjogron B: Fat-reduced diet in the symptomatic treatment of small bowel disease. Gut 15:351–359, 1974
Ammon HV, Phillips SF: Inhibition of colonic water and electrolyte absorption by fatty acids in man. Gastroenterology 65:744–749, 1973
Edmonds CJ: Absorption of sodium and water by the human rectum measured by a dialysis method. Gut 12:356–362, 1971
Author information
Authors and Affiliations
Additional information
This work was supported by Grant No. 3666 from the endowment of Thomas T. Dee and George F. Moody through Evanston Hospital.
Rights and permissions
About this article
Cite this article
Mitchell, J.E., Breuer, R.I., Zuckerman, L. et al. The colon influences ileal resection diarrhea. Digest Dis Sci 25, 33–41 (1980). https://doi.org/10.1007/BF01312730
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01312730