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Patient care — surgical procedures

Small bowel resection: Small bowel resection is surgical removal (resection) of a diseased portion of the small bowel (small intestine).

Small bowel resection is performed while the patient is under general anesthesia (unconscious and pain-free). An incision is made in the abdomen. The diseased part of the small intestine (ileum) is removed and the two healthy ends are sewn back together (resected). The abdominal incision is closed.

If it is necessary to spare the small intestine from normal digestive work while it heals, a procedure called an ostomy may be used. An opening called a stoma is made from the intestine through the abdominal wall. The proximal (nearer to the stomach) end of the healthy bowel tissue is then passed through the abdominal wall, and the edges are stitched to the skin of the abdominal wall. An adhesive drainage bag (stoma appliance) is placed around the opening.

In most cases, depending on the disease process being treated, small bowel stomas are temporary and can be closed with another operation at a later date. If a large portion of the bowel is removed, the ostomy may be permanent.

The ileum absorbs much of the fluid from foods. When the large intestine is bypassed by an ileostomy, the patient should expect liquid stool (feces) from the ostomy bag. The constant or frequent drainage of liquid stool can cause the skin around the ostomy to become inflamed. Careful skin care and a well-fitting stoma appliance can reduce this irritation.

Indications: Resection of the small bowel may be recommended for conditions such as the following:

  • Blockage of the intestine (intestinal obstruction) due to scar tissue or deformities
  • Bleeding, infection, or ulcers due to inflammation of the small intestine (regional ileitis, Crohn's disease)
  • Injuries
  • Cancer
  • Precancerous polyps
  • Benign tumors

Risks:

  • Reactions to medications
  • Problems breathing
  • Bleeding
  • Infection
  • Intestinal leaks
  • Bulging through the incision (incisional hernia)
  • Narrowing (stricture) of the opening (stoma)
  • Blockage (obstruction) of the intestine from scar tissue

Expectations after surgery: The outcome depends on the disease process being treated.

Convalescence: Most patients will stay in the hospital for 5 to 7 days. Complete recovery from surgery may take 1 to 2 months. During the first few days after surgery, eating is restricted. Further surgery may be needed to close the hole and discontinue use of the ostomy bag.

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