saudigastro.com/patients/intestinal-failure
Category
Serious
Red flags
6
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
The small intestine absorbs most of the nutrients, water and salts from what we eat. In intestinal failure the working gut is not enough to do this, and the person cannot stay well without help. Help may mean extra fluids, vitamins and minerals, tube feeding, or parenteral nutrition (PN), which is a nutrition solution given directly into a vein through a thin tube. Intestinal failure can be short-term, for example after major surgery, or long-term (chronic).
How common is it?
Chronic intestinal failure is rare, but acute intestinal failure after major surgery or illness is seen more often in hospitals. Long-term cases are usually looked after in specialised centres.
Why does it happen?
Common causes are short bowel syndrome (when a large part of the small intestine has been removed or does not work, for example after surgery for Crohn's disease, blocked blood supply, or twisting of the bowel), motility disorders where the gut muscles do not move food along properly, extensive disease or damage of the gut lining, and long-term blockage or fistulas of the bowel. In children, causes include birth defects of the bowel.
Symptoms
- Persistent diarrhoea or a large volume of watery output, or high output from a stoma
- Weight loss and muscle loss
- Thirst, dry mouth, dizziness and passing little urine from dehydration
- Tiredness and weakness
- Cramps, muscle twitching or tingling from low salts or minerals
- Vitamin and mineral deficiencies, for example easy bruising, bone pain, or night-vision problems
- In children, poor growth and slow weight gain
Red flags — seek urgent medical care
Severe dehydration: very dry mouth, dizziness on standing, confusion, very little urine, or fainting
This is an emergency and you may need fluids through a vein. Go to the emergency department now.
Fever or chills, especially if you have a feeding line (catheter) in a vein
Could be a bloodstream infection from the line, which can become life-threatening. Go to the emergency department immediately and tell them you have a feeding line.
Redness, pain, swelling or pus at the line site, or arm or neck swelling
May mean a line infection or a clot. Seek urgent medical care.
Severe belly pain, repeated vomiting, or a swollen belly with no output
Could indicate a blockage. This is an emergency.
Yellow skin or eyes, or new severe tiredness and confusion
Liver problems and other complications can arise with long-term feeding. Contact your team or go to the emergency department.
A baby or child with this condition who is lethargic, not feeding, vomiting repeatedly, has a dry mouth, no wet nappies, or a fever
A baby or child needing urgent care must be seen immediately. Go to the emergency department now.
How is it diagnosed?
Doctors look at how much you eat and drink, the amount and type of stool or stoma output, your weight, and blood tests for minerals, vitamins, kidney and liver function. They also work out the cause using imaging such as CT, MR enterography (an MRI of the small bowel) and sometimes endoscopy, and may measure the remaining length of bowel from operation notes. Tests for how well the gut moves and absorbs may be added. A multidisciplinary team of gastroenterologists, surgeons, dietitians and nurses usually decides the plan.
What the latest science says
Care has improved with specialist intestinal rehabilitation programmes that aim to help the remaining gut adapt and reduce dependence on intravenous feeding. Some medicines that support absorption or reduce fluid loss can help selected people. Bowel transplantation is reserved for a small number with serious complications.
Outlook — what to expect
Outlook depends on the cause, how much healthy bowel remains, and access to specialist care. Some people recover enough to stop intravenous feeding, particularly when the gut can adapt over months to years. Others need support long term, and with good care many people live active lives at home. Complications, such as line infections, dehydration, and liver or bone problems, are the main risks and are reduced by close monitoring.
Treatment
Habits & Lifestyle
Your specialist team directs your care. Never change your feeding or fluid plan on your own.
- Follow your nutrition plan and attend all monitoring visits and blood tests
- If you have a feeding line, wash hands before touching it and follow your nurses' training exactly
- Weigh yourself regularly and record fluid in and out, as your team advises
- Keep emergency contact numbers and a care plan with you, and know when to call
- Keep active within your limits to protect muscles and bones
Diet
Diet is individual and set by a dietitian. Eating by mouth is encouraged where possible, since it helps the gut adapt.
- Eat small, frequent meals and snacks as advised
- Your dietitian may adjust fluids, salt and sugar, as drinking large amounts of plain water or sugary drinks can sometimes increase losses
- Oral rehydration solutions may be advised in some people
- Vitamin, mineral and trace element supplements are often needed; take only those prescribed
- Do not follow restrictive or fad diets
Medications
Medicines are used to slow gut transit, reduce secretions and protect nutrition. Your team decides on the types and the amounts.
- Anti-diarrhoeal medicines to slow the gut
- Acid-reducing medicines to cut down stomach secretions in some people
- Parenteral nutrition or intravenous fluids as prescribed
- Medicines that support gut adaptation in selected people under specialist care
- Treatment of small bowel bacterial overgrowth, if present
Procedures & Surgery
Procedures are matched to the cause and to what the remaining bowel can do.
- A central venous catheter or similar line for intravenous feeding
- A feeding tube into the stomach or bowel in suitable people
- Reconnecting a bowel opening or restoring continuity when it is safe
- Surgery to lengthen or reshape the bowel in selected people
- Bowel transplantation in carefully selected people at specialist centres
Living with the condition
- Home parenteral nutrition is possible with training and support from a specialist team
- Many people need psychological and social support; ask your team about it
- Keep your team informed before travel and plan supplies carefully
In the Saudi context
If you wish to fast in Ramadan, discuss it with your specialist team well in advance. Fasting is often not safe for people who depend on fluids or nutrition from a vein or who lose fluid easily, and your doctor will advise you on what is right for you.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- What is the cause of my intestinal failure and is it likely to improve?
- Do I need parenteral nutrition and for how long?
- What signs of infection or dehydration should make me call or come in?
- Which supplements and tests do I need?
- Can I travel, work or fast in Ramadan?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide