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Small Bowel Surgery

Dr. Patta Radhakrishna

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Small Bowel Surgery

Small intestine:
One of the most frequently done procedures in surgical practice, surgery on the small intestine includes small bowel obstruction surgery and small bowel resection surgery.

Some of the most common conditions that lead to small intestine surgery include:
  • Tuberculosis of the intestine:
Tuberculosis, in India, commonly attacks on small intestine. The small intestinal association is in the part of distal small bowel and proximal colon called 'ileo-caecal tuberculosis'. In this condition, there is usually a progressive obstruction to the lumen of the bowel that further leads to constipation and diarrhea. The condition requires surgical treatment in the form of limited resection of the ileo-caecal region.
  • Small bowel perforation
Typhoid ulcers cause perforation and peritonitis which is an absolute emergency and should be tackled right away without delay. In this, laparotomy and closure of perforation is required.
  • Bleeding from the small bowel
Small Bowel Obstruction Surgery Small Bowel Resection Surgery

Small bowel bleeding is an uncommon condition that is hard to diagnose. Often termed as 'obscure GI bleeding', it can lead to a slow chronic ooze or massive bleeding all of a sudden. For diagnosing this condition, there is required a variety of investigations like capsule endoscopy; enteroscopy and a nuclear scan. This exactly localizes the site of bleed which is removed surgically.
  • Crohn’s Disease
Crohn's Disease is another condition of the small intestine with chronic diarrhea and weight loss. It can be seen more often these days than before. Now, there are available specific investigations to diagnose this condition with precision. Some of the patients may require long-term medical treatment. Several patients can also develop bowel obstruction, internal fistulae requiring repeated operations.
  • Tumor
Tumors of the small bowel are either adenocarcinoma or lymphoma presenting with bleeding and or obstruction. These need to be removed with a wide margin. In the small intestine, gastrointestinal stromal tumors are seen quite often requiring excising a segment of the involved bowel.
  • Gangrene
Severe abdominal pain and distension is caused due to sudden occlusion of the blood supply to the small intestine leading on to gangrene of the small bowel. This requires surgical removal of the damaged intestine after urgent accurate diagnosis.
  • Obstruction – incarceration in a hernia and trauma to the intestine are some of the other common conditions requiring surgery on the small intestine.

Colorectal Surgery

Surgery for Familial polyposis coli:
This is a rare hereditary disease of the colon indicated with multiple polyps all over the colon. This condition requires complete removal of the colon and rectum as it has a high malignant potential. The continuity of bowel is restored by performing an ileo-anal pouch.

Colorectal surgery

Surgery for ulcerative colitis:
An inflammatory disease of the large bowel, ulcerative colitis varies in severity. Ascends towards the caecum, it usually starts from the rectum. In India, most of the patients suffer from a milder form of ulcerative colitis that is localized to the left colon and can be subsidized with oral medication.
Some of the patients with severe symptoms are present in the emergency ward. They require hospitalization and sometimes surgery for conditions like 'toxic megacolon', massive lower GI bleeding etc. Surgery will involve total colectomy with ileostomy.

Elective surgery for extensive ulcerative colitis or pancolitis or cancer in a setting of ulcerative colitis will include removal of the entire colon and rectum called "total procto-colectomy" and the normal continuity is restored by creating an 'ileo-anal pouch'. This procedure generally avoids an ielostomy.

Surgery for diverticulitis:
Diverticulitis is a condition which is common in old people. In old people, areas of weakness develop in the sigmoid and ascending colon result in localized ballooning of colonic mucosa called diverticulosis. Diverticulitis is the condition that results due to infection and inflammation of the diverticuli. This condition if present with colonic obstruction, colo-vesical fistula or uncontrollable bleeding, require surgery. Surgery will be in the form of resecting the involved segment and anastomosis.

Colorectal surgery

Surgery for Cancer of Colon and rectum:
Cancer is one of the common diseases of the colon and rectum. It can also affect any part of the large bowel. The primary treatment involves surgical removal of the cancer. In rectal cancers, complete removal of the rectal apparatus with a permanent end colostomy is done. In some of the cases of rectal cancers, surgical staplers are used for preserving anal sphincter mechanism. Cancers of the colon will require removal of a part of the colon called Right or Left hemi-colectomy.

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