Small intestine removal (resection); Ileostomy |
procedure in which a part of the diseased portion of the
small intestine (small bowel) is removed or
- Bowel resection may be performed to treat various disorders of the intestine, including cancer, pre-cancerous polyps, Intestinal Blockage (obstruction), Inflammatory Bowel Disease (Crohn's, ileitis), ulcers, ruptured diverticulum, familial polyposis, compromised blood supply, traumatic injury, bleeding or infection.
- Upon admittance to the hospital,
the patient is asked to sign a consent form acknowledging
that they understand the risks and benefits of the surgery
they are about to undergo, and its possible consequences
- To prepare for surgery, the patient is put on a low
residue diet for several days prior to surgery, and then
changed to a liquid diet at least the day before surgery,
with nothing taken by mouth (NPO) after midnight. This
diet, along with the use of enemas and/or potent
laxatives, (such as GoLytely or Colyte), is ordered to
help empty the bowel of stool, and prepare it for a clean
and safe operation. The bowel is full of bacteria, and
when the bowel is opened, there is an increased risk of
operative infection. Thus, antibiotics (e.g., neomycin,
erythromycin) are given prior to operating, to reduce the
risk of such infections.
- A nasogastric tube (NGT) is inserted through the nose into the stomach, on the day of surgery to remove gastric secretions and prevent Bloating, nausea,
- An intravenous catheter is inserted into a vein in the
arm so that fluids and medications can be given
- A urinary catheter (thin tube inserted into the
bladder) is also inserted to keep the bladder empty during
- Generally, a few days before the actual surgery, preoperative blood, urine, radiographs (chest X-Rays, abdominal films, etc.) and a cardiac evaluation (EKG) are all done. If any of the results are abnormal, surgery is withheld until the appropriate treatment and correction of abnormalities have been accomplished. If, for example, a heart problem or lung problem is identified, the appropriate specialist is called in to evaluate the problem and correct it before surgery. When completed, the patient is ready to undergo the resection.
- The surgery involves cutting the abdomen partially or
fully open, and removing the diseased portion of
intestine; then rejoining the healthy and functional ends.
In this case, the intestine is once again a healthy
tubelike structure, through which stool can pass, now that
the diseased part has been removed. The patient's stool is
often more watery than normal after such surgery and,
depending on the portion of intestine removed, certain
vital nutrients (vitamins, minerals) may be lost and need
to be supplemented for life.
- In some cases it is necessary to remove the diseased
portion of the bowel and then bring the healthy end of the
intestine onto the surface of the abdomen, forming a
temporary or permanent opening called an ostomy. In this
case, the stool empties through this opening into an
ostomy plastic bag, which will require emptying when full.
Use of the large intestine to form the ostomy results in a
"colostomy". If the small intestine is used, to form the
ostomy, the opening onto the skin is a "jejunostomy" or an
"ileostomy" depending on which portion of small intestine
- In certain instances, after the bowel has rested, a second operation is done to rejoin the two ends of the intestine when it is safe to do so. In other cases, the ostomy may be permanent.
- After surgery (post-operative period), the patient is transferred to the critical care unit where blood pressure, pulse, respiration, and temperature are closely-monitored. The patient is also monitored for excessive bleeding, wound infection, and Thrombophlebitis (inflammation, and blood clot formation in the veins); the latter is a serious complication that may occur in patients, requiring extended recuperation in a prone or sitting position (as a clot may travel from the legs to the lungs, and result in a dangerous Pulmonary Embolism).
- There is also a risk of Pneumonia
post-operatively, as the patient may be on painkillers and
have difficulty taking deep breaths. For this reason, the
patient is often seen by a respiratory therapist and given
breathing exercises, pre-operatively and post-operatively.
- Further, until the patient is fully recovered, fluid
intake and output is monitored, and output is replaced as
- The wound site is cleaned regularly and dressings are
done to prevent infection. Sometimes, a portion of the
intestine bulges out and projects through the weakened
muscle wall surrounding the surgery site. This is a
hernia. If a hernia occurs, it may require surgical
correction (if large enough).
- The doctor is notified if the patient's condition
changes for the worse, or if there is increased pain,
swelling, redness, drainage, or bleeding in the surgical
area; confusion; fever; severe nausea or vomiting; rectal
bleeding; or black, tarry stool.
- Finally, the nasogastric tube will remain in place, attached to low intermittent suction until the surgeons agree that the patient can tolerate food by mouth. The patient's diet can gradually be resumed, beginning with liquids and advancing to a regular diet as tolerated. The patient will be given fluid and Electrolytes intravenously until he or she is strong enough and stable enough to be moved out of the intensive care unit. After sufficient healing, the patient is discharged home with instructions on medications to take, follow up appointments, dressing changes, and ostomy care.