Definition and Overview

The small bowel or small intestine is the tube that connects the stomach to the colon (large intestine). It is the part of the digestive system responsible for absorbing nutrients from the food a person eats. The organ is made up of three segments, namely:

  • Duodenum - The first and shortest segment that receives partially digested food from the stomach.

  • Jejunum - The middle segment where most nutrients from food are absorbed.

  • Ileum - The last segment that intersects with the large intestine.

Any of these parts can be damaged and if the damage is beyond repair, small bowel resection can be performed. Depending on which part is removed, the procedure is referred to as duodenectomy (removal of all or part of the duodenum), jejunectomy (excision of all or part of the jejunum), or ileectomy (removal of all or part of the ileum).

Who Should Undergo and Expected Results

Small bowel resection is used to treat the following conditions:

  • Cancer of the small intestine - Malignant tumours can form in the small intestine and cause a blockage. In the majority of cases, doctors elect to remove the section where the cancer is found to treat the condition. The surgery is often followed by chemotherapy or radiation therapy to ensure that no cancer cells remain in the small intestine. Small bowel resection is also used if precancerous polyps and noncancerous tumours are found in the organ.

  • Crohn’s disease - Crohn’s disease is a painful and debilitating inflammatory bowel disease that is associated with a number of life-threatening complications. It is initially treated with lifestyle changes and drug therapy with surgery reserved as the last option. If patients are unable to experience symptoms relief with non-invasive treatments, small bowel resection is performed.

  • Severe ulcers - Ulcers refer to holes in the mucous membrane of the small bowel. They usually occur due to infections or cancer and often cause severe bleeding.

As for the expected results, most patients recover well from surgery while some experience complications including problems with absorbing enough nutrients, which can lead to malnutrition.

How is the Procedure Performed?

Prior to the procedure, the patient undergoes blood, urine, and imaging tests as well as electrocardiogram (EKG). The surgeon will also discuss the details of the surgery, the technique to be used, and possible risks and complications. Preoperative bowel preparations, such as completely cleaning the bowel and taking antibiotics, are standard practice.

Before the actual surgery, a nasogastric tube is inserted through the nose. It prevents vomiting and nausea as well as removes gastric secretions during the procedure. A urinary catheter is also used to keep the bladder empty.

Small bowel resection can be performed either through traditional open surgery or laparoscopically.

In a traditional open surgery, the surgeon makes a long incision in the abdominal wall to access and remove the diseased part of the intestine. The same is the goal of laparoscopic surgery, which uses up to five small incisions where a miniature camera, light, and surgical tools are inserted. The two healthy ends of the resected small intestine are then stapled or sewn together (anastomosis). If this is not possible, the surgeon will create an opening in the belly called a stoma where the end of the resected intestine is attached.

Many surgeons and patients prefer laparoscopic surgery because it is minimally invasive. Patients typically recover faster because their wounds are much smaller and the interruption to their digestive system is minimal.

The procedure, which is often performed under general anaesthesia, can last between one to four hours. Following surgery, patients are transferred to a recovery room until the effects of anaesthesia wear off. They are then moved to a regular hospital room where they typically stay for a week before being discharged.

Possible Risks and Complications

Most people who undergo small bowel resection recover fast and return to their normal activities weeks after the procedure. Some, however, suffer from chronic diarrhea and malnutrition as the small intestine’s ability to absorb enough nutrients from food has been compromised.

Small bowel resection rarely leads to serious risks and complications. However, a small number of patients experience the following:

  • Excessive bleeding

  • Scar tissue formation resulting in the blockage of intestine

  • Infection

  • Hernia at the incision site

The risk of complication is higher in patients who are smokers, malnourished, or suffering from chronic illnesses or have undergone abdominal surgery in the past.

Patients are discharged about a week following a small bowel resection. They are urged to call their doctor if they develop any signs of infection, persistent abdominal pain, rectal bleeding, chest pain, and urinary symptoms.

References:

  • Small bowel resection. (2015, January). http://www.mountsinai.org/patient-care/health-library/treatments-and-procedures/small-bowel-resection

  • Bines, J. E., R. G. Taylor, F. Justice, et al. “Influence of Diet Complexity on Intestinal Adaptation Following Massive Small Bowel Resection in a Preclinical Model.” Journal of Gastroenterology and Hepatology 17 (November 2002): 1170–1179.

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