Various medical conditions, such as Crohn’s disease, mesenteric ischemia, radiation enteritis, volvulus, and trauma, may cause damage to the intestinal tract. When the injury is severe, surgical removal of the diseased small bowel may be necessary.
Short Bowel Syndrome (SBS) occurs when surgical management of these medical conditions requires repeated or extensive small bowel resection that leads to a markedly shortened small bowel length, particularly when there is 100 cm of small bowel with a portion of the colon present or 150 cm of small bowel where there is no colon remaining.
SBS is characterized by intractable diarrhea, weight loss, dehydration and malnutrition. Electrolyte abnormalities, vitamin and mineral deficiencies, kidney stones and gallstones may also occur. The etiology of these symptoms is twofold: Either the amount of bowel needed for absorption of nutrients and fluids is insufficient or the quality of the remaining bowel is very poor.
The extent to which the symptoms of short bowel syndrome manifest themselves depends on various factors:
- The disease that caused the damaged bowel as well as the amount of disease activity remaining in the preserved bowel.
- The amount and location of the intestine that was removed.
- The likelihood that the remnant is able to assume functions of the bowel that have been removed (a process known as intestinal adaptation).
- Whether the ileocecal valve (a valve between the small intestine to the colon or large intestine) is removed.
The Social Security Administration (SSA) evaluates SBS under a special definition of a disability called a “listing.” The listing for this impairment is 5.07. In order to meet this listing, the claimant must show that he or she has short bowel syndrome
due to surgical resection of more than one-half of the small intestine, with dependence on daily parenteral nutrition via a central venous catheter.
The management of SBS requires long‑term parenteral nutrition via an indwelling central venous catheter (central line); the process is often referred to as hyperalimentation or total parenteral nutrition (TPN). Individuals with SBS can also feed orally, with variable amounts of nutrients being absorbed through their remaining intestine. Over time, some of these individuals can develop additional intestinal absorptive surface, and may ultimately be able to be weaned off their parenteral nutrition.
A claimant’s impairment will continue to meet 5.07 as long he or she remains dependent on daily parenteral nutrition via a central venous catheter for most of your nutritional requirements. Long‑term complications of SBS and parenteral nutrition include central line infections (with or without septicemia), thrombosis, hepatotoxicity, gallstones, and loss of venous access sites. Intestinal transplantation is the only definitive treatment for individuals with SBS who remain chronically dependent on parenteral nutrition.
To document SBS, SSA needs a copy of the operative report of intestinal resection, the summary of the hospitalization(s) including: Details of the surgical findings, medically appropriate postoperative imaging studies that reflect the amount of your residual small intestine, or if we cannot get one of these reports, other medical reports that include details of the surgical findings. We also need medical documentation that the claimant is dependent on daily parenteral nutrition to provide nutritional requirements.