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Small bowel resection

Before you agree to have your bowel problems treated by surgery it is sensible to know all you can about it. The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

 

 

What is the problem?

Part of your small bowel, also known as your small intestine, is diseased. You need to have this part of the bowel removed and the bowel ends joined together.

 

What is the small bowel?

The small bowel is the upper part of the bowel, beyond the stomach. It is narrower than the large bowel, which it joins in the right hand side of the tummy near the appendix. It is about 500cm (16 feet) long.

 

The small bowel starts in the right side of the tummy, where it is called the duodenum, which is about 20cm (6 inches) long. The next 250cm (8 feet) or so of the small bowel is called the jejunum. The rest of the small bowel is called the ileum. The ileum joins the large bowel at the lower right of the tummy, near the appendix.

Small bowel resection

What has gone wrong?

The most common reason for a small bowel operation is a blockage. This is usually due to scarring, called adhesions, or a rupture, called a hernia. The bowel may simply be pressed on, at one point. This makes the bowel above the obstruction swell up. The food and digestive juices build up, causing vomiting and loss of water and salts from the body.

 

If a loop of bowel becomes trapped or twisted, it will obstruct the bowel above it. In addition, the loop of bowel itself can die and cause a life-threatening infection throughout the body, called blood poisoning or septicaemia.

 

Less often there is a thickening of the ileum and other parts of the bowel caused by an inflammatory bowel disease (IBD) such as Crohn’s disease. Sometimes food or a gallstone blocks the bowel. A sharp piece of food, such as a fish bone, can pierce the bowel wall.

 

Rarely, the bowel is damaged by a blockage of its blood supply, called bowel ischaemia. Another rare cause is a tumour, which may be non-malignant (benign) or malignant (harmful).

 

It is also possible that the bowel may be damaged due to a previous operation. Some instruments used in keyhole surgery or to drain fluid from the tummy cavity could have been the cause.

Small bowel resection 2

The aims

The aims are threefold

 

  • To remove any damaged or diseased bowel.

  • To join the ends of healthy bowel together.

  • To prevent the problem from coming back again.

 

You would have a general anaesthetic and be completely asleep for the operation.

 

The benefits

You should stop having pain and vomiting. A hernia swelling should be gone. The cause of the small bowel problem should be gone.

 

Are there any alternatives?

Simply waiting and seeing if an obstruction settles down can be reasonable. This would be if the symptoms are not severe and if the blockage may be just a plug of food, which could pass through the bowel without an operation. The waiting could be a matter of hours, or rarely a day or two, if obstruction seems only partial. However, most of the small bowel conditions mentioned earlier usually need surgery as soon as possible.

 

Drug treatment for inflammatory bowel disease works well for many patients, but some will also need an operation.

 

Bypassing a diseased part of bowel may be safer than removing it, if the bowel is very stuck in the tummy. Rarely, making a stoma, which is a new opening for bowel waste on the skin of the tummy, above the diseased part, is the best that can be done.

 

A very large hernia may have several loops of bowel caught up in it, but with only one loop damaged. It may be safest to remove the damaged bowel but leave the hernia repair to a later date.

 

Taking laxatives can be dangerous, making the bowel condition worse.

 

Sometimes, there is only a little damage to the bowel e.g. caused by a needle. A trial of antibiotics and possibly washing out the tummy cavity with a tube passed through the tummy wall, is worth trying.

 

Author: Mr Michael Edwards FRCSEng FRCSEd. Consultant general surgeon.

© Dumas Ltd 2006

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