Intestinal failure is defined as the reduction in the functioning gut mass below the minimal amount necessary for the absorption of nutrients and a normal nutritional status. The main cause of chronic intestinal failure in adults is short bowel syndrome secondary to mesenteric ischemia. In short bowel the remnant bowel length is inferior to 200 cm. The two other causes of intestinal failure are extensive small bowel mucosal diseases and chronic intestinal pseudo-obstruction. The reference treatment of severe chronic intestinal failure is home parenteral nutrition. The main alternate for irreversible intestinal failure is small bowel transplantation, isolated or combined to liver transplantation.