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The likelihood of developing an SBS-associated IF depends on the residual small bowel length in continuity and on several ��concomitant pathophysiological mechanisms�� related to the anatomy, integrity, function and adaptive potential of the small bowel remnant as well as to the underlying clinical condition [15], [22]?and?[49]. The post-resection intestinal adaptation is a spontaneous process that attempts to ensure a more efficient absorption of nutrients per unit length of the remaining bowel [15]?and?[22]. This occurs partly by increasing the absorptive area (structural adaptation) and/or by slowing the gastrointestinal transit (functional adaptation). It is promoted by the presence of nutrients in the gut lumen, by the pancreatic and biliary secretions and by gut hormones mainly produced by the ileum and colon, and usually takes place over 1 or 2 years. Atezolizumab cost Post-operative intestinal adaptation appears to be absent or impaired in the presence of an end-jejunostomy Ipilimumab mw [15]?and?[22]. In adults, a high risk for developing IF due to inadequate length of small bowel in continuity has been reported when there is less than 35?cm small bowel with a jejunoileal anastomosis with an intact colon, less than 60?cm small bowel with a jejunocolic anastomosis or less than 115?cm small bowel with an end-jejunostomy [22]. Other mechanisms contributing to IF may be, excessive fluid and electrolyte intestinal losses in the presence of an end jejunostomy, restriction of oral nutrient intake in an attempt to decrease the intestinal losses, reduced oral intake because of underlying disease-related hypophagia and failure to develop the post-resection adaptive hyperphagia [22]?and?[49]. SBS-associated IF may be reversible because of the intestinal adaptation process and/or intestinal rehabilitation programs [4] based on medical and surgical tretments. The probability of weaning off HPN has been reported to be about 50% in adults and up to 73% in children. Complete weaning off HPN in patients with SBS is unlikely (Nivolumab mw the other organs (eg the bladder), or between the gastrointestinal tract and the skin (enterocutaneous fistulas, EC) [10], [34], [35], [52], [53]?and?[54]. About 75�C85% of EC fistulas form after surgery as a result of bowel injury, inadvertent enterotomy and/or anastomotic leakage, in the presence of malignancy or inflammatory bowel disease, and with attempted surgical division of dense adhesions. In the remaining 15�C25%, EC fistulas form spontaneously secondary to underlying pathology, in particular Crohn's disease. Other causes include radiation enteritis, diverticular disease, malignancy, intra-abdominal sepsis and trauma.