A patient undergoes massive small bowel resection. Which single segment, if lost, produces the most severe and least compensable malabsorption syndrome?

• A Proximal jejunum
• B Mid-ileum
• C Duodenum
• D Terminal ileum ✓

Explanation

The terminal ileum is the sole site of active vitamin D12 and bile salt absorption, and neither function is compensated by other segments. Loss causes bile salt wasting, steatorrhoea, D12 deficiency and gallstone and oxalate stone risk. Jejunal resection is better tolerated because the ileum adapts to absorb most nutrients, and the duodenum handles mainly iron, calcium and folate with substantial distal compensation.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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