Intestinal Fortitude

How much guts does it take to survive? Nature supplies man with an average 25 feet, four-fifths of it in the small intestine (comprising the duodenum, ileum and jejunum). Through the small intestine's walls the body absorbs nourishment. When part of this live plumbing becomes diseased, it can be cut out. But doctors have never known exactly how little could be left without dooming the patient to death from malnutrition.

Last week the University of California's Dr. Theodore Leonidowitch Althausen suggested an answer: the human body can readjust itself, and learn to function almost normally, with anything more than two feet of jejunum plus the duodenum. Estonian-born Dr. Althausen had previously described a case in which a woman was left with only 18 inches of vital gut she died of malnutrition after three years. Now in Gastroenterology, Dr. Althausen and three colleagues described two cases in which, with but little more small intestine the patients were living normally.

Grubs in the Garden. A 28-year-old California housewife, mother of three was relieved of the ileum and all but two feet of the jejunum, leaving her (with the duodenum) about three feet of small intestine. After two years, her only complaint is diarrhea, usually traceable to fatigue or strain. She does all the housework and scrabbles in the garden without ill effects.

Because such cases are far from common, Dr. Althausen counted himself lucky when, on a visit to Australia last year, he ran across a third and most unusual case A wiry, freckled, 50-year-old seaman named Bergman had been left with only two feet of jejunum and duodenum. He worked on a soot-grimed freighter pitching and rolling across Bass Strait between Melbourne and Tasmania. Althausen and Melbourne's Dr. Ronald Doig made one interesting discovery in studying the sailor: it made no difference to his two feet of small intestine whether he got predigested or ordinary food. Says Althausen: It proved to be 'just as good for him to have steaks and chops as that predigested mush, which is very expensive and tastes bad."

Grub Afloat. A jolly type with a weather eye for pretty nurses, Bergman had made a quick comeback from the operation; in ten weeks he was back aboard the freighter on light duty. Three months later Dr. Doig let him go back to normal hours and duties. "He must be all right," says Althausen, "or he couldn't eat that ship's food. If you can stand that, you can stand anything."

There are four ways, the four researchers found, in which nature helps the body to adjust itself after such radical surgery 1) some lost weight stays lost; 2) the absorptive power of the bowel wall increases; 3) the remaining small bowel gets bigger (it may double in diameter), allowing still more absorption; and 4) the large intestine learns to do some of the work of the shortened small intestine.

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