Definition and Overview

The colon, also known as the large intestine, is connected to the small intestine by the ileum. When certain gastrointestinal conditions cause irreversible damage to both the colon and the ileum, it sometimes becomes necessary to remove them both through a surgical procedure.

The removal of the colon is called large bowel resection, colectomy, or simply colon resection surgery. When the ileum is also removed during the same procedure, it is called an ileocolic resection or an ileocolectomy.

Who Should Undergo and Expected Results

Colon and ileum removal is commonly performed on patients who suffer from gastrointestinal conditions that affect their colon and ileum. These include:

  • Inflammatory bowel diseases, especially Crohn’s disease – While there are many different types of inflammatory bowel diseases, Crohn’s disease is the first indication for ileocolectomy as it affects both the colon and the ileum.

  • Colon or ileum polyps or lesions

  • Lower gastrointestinal hemorrhage

  • Colorectal cancer

  • Traumatic injury to the abdomen such as perforation or gunshot wounds

  • Birth defects

The procedure removes the damaged part of the colon and the damaged part of the terminal ileum to relieve any symptoms the patient may be experiencing. It is beneficial for those who are suffering from lifelong inflammatory bowel diseases that cause the intestines to become chronically inflamed resulting in abdominal cramps, diarrhea, rectal bleeding, and even fatigue. Chronic inflammation may even cause bowel perforations, ulcers, or lead to the development of an abnormal connection called a fistula. Thus, these diseases tend to get in the way of patients’ ability to live normally, especially since medications only provide temporary relief and cannot really cure the disease. For this reason, up to 75% of patients who suffer from Crohn’s disease choose to undergo surgical treatment.

Patients who undergo ileocolic resection do not require a colostomy or an ileostomy. A colostomy is an opening in the abdominal wall through which the colon is diverted, while an ileostomy is an opening in the lower right side of the abdomen through which the small intestine is diverted. These are necessary when only either the colon or the ileum is removed, but not both. However, in a procedure that removes both the colon and the ileum, a colostomy or ileostomy is not typically necessary.

How is the Procedure Performed?

Due to the popularity of minimally invasive surgical methods, even colon and ileum removal can now be performed without making a large abdominal incision. The procedure can be done through laparoscopic or keyhole surgery. This means that patients experience less pain, less bleeding, and a shorter recovery time.

Once the diseased parts of the colon and terminal ileum have been removed, the surgeon will make a surgical connection (anastomosis) between the small intestine and what remains of the large intestine using sutures or surgical staples. The entire procedure usually takes around 2 hours.

However, in some cases, surgeons encounter problems while performing minimally invasive keyhole surgery preventing them from achieving the goal of the procedure. If this happens, they will make an abdominal incision to access the problem areas and perform the surgery in a traditional manner.

Following the removal of the colon and ileum, the removed organs are sent to a pathologist for closer examination, which may take a couple of weeks.

The patient is often asked to stay in the hospital for the first 24 hours or longer after the surgery, during which they will have an intravenous drip and a catheter drain in place. Some may need to stay until they can resume normal fluid intake, which means that the intestines are already working properly. This may take two to five days for those who undergo keyhole surgery or up to 7 days for those who undergo an open surgery.

Upon being discharged from the hospital, patients still need to avoid strenuous activities, such as heavy lifting, for about six weeks. They are, however, advised to stay active and mobile without straining their bodies. They are allowed to resume driving two weeks after a laparoscopic colon and ileum removal, but the wait may be longer if they undergo an open surgery.

Patients are scheduled for a follow-up appointment two weeks after the procedure and are advised to go to the doctor anytime they experience any worrying symptoms following the surgery.

Possible Risks and Complications

Patients who undergo an ileocolic resection may face certain risks including suffering from short bowel or short gut syndrome. This disorder develops when a large part of the small intestine, including the ileum, is removed, resulting in a shorter small intestine. This may also lead to malabsorption.

Colon and ileum removal surgery may also have several effects on a person’s health. Thus, patients undergo a comprehensive heart and lung assessment to make sure they are healthy enough for the procedure and that the risk of them suffering from major health issues is minimal. Patients are also advised to wear compression stockings to help prevent thrombosis or blood clots from forming during and after the surgery.

Other risks involved include:

  • Bleeding

  • Wound infections

  • Blood loss (in some cases, patients require a blood transfusion)

  • Anastomotic leak – An anastomotic leak can be resolved by placing a drain through the abdominal wall. However, if it cannot be repaired or if it is too big, the patient may require ileostomy surgery.

  • Obstruction or blockage

  • Abdominal distension

  • Vomiting

The last two risks may occur when the bowel is taking longer than normal to heal. In such cases, the patient has to go on bowel rest with the help of intravenous feeding or a nasogastric tube.

The risk of developing complications mentioned above is lower for those who undergo laparoscopic surgery. Keyhole bowel resection is a safer alternative to its traditional equivalent, although its success heavily depends on the skill of the surgeon.

References:

  • Sangster W, Berg AS, Choi CS, Connelly TM, et al. “Outcomes of early ileocolectomy after percutaneous drainage for perforated ileocolic Crohn’s disease.” The American Journal of Surgery. 2016 October. 2012(212)4:728-734. http://www.americanjournalofsurgery.com/article/S0002-9610(16)30213-6/abstract

  • Makni A. et al. “Laparoscopic-assisted versus conventional ileocolectomy for primary Crohn’s disease: Results of a comparative study.” J Visc Surg. 2012 October. 150(2): 137-143. https://www.ncbi.nlm.nih.gov/labs/articles/23092647/

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