Small intestine

Surgery on the small intestine is one of the most frequently done procedures in our surgical practice which include Small Bowel Obstruction Surgery and Small Bowel Resection Surgery. Where most of the conditions could be treated with medicines small bowel obstruction and adenocarcinoma of the small bowel essentially require surgery.

Some of the conditions that cause disruptions in the small bowel and require surgical intervention are outlined below.

Tuberculosis of the intestine: Small intestine is one of the common sites of tuberculosis in India and even associated with HIV. The small intestinal involvement is in the region of distal small bowel and proximal colon called ‘ileo-caecal tuberculosis’ This condition usually presents with progressive obstruction to the lumen of the bowel leading on to constipation and diarrhea. This requires surgical treatment in the form of limited resection of the ileo-caecal region. A tuberculous intestine is usually an emergency procedure.

Small bowel perforation: Typhoid ulcers leading onto perforation and peritonitis requiring emergency laparotomy and closure of perforation is not uncommon in our practice. This is an absolute emergency and should be tackled right away without delay. The surgery aims at correcting the anatomical problem and removes any foreign material that might have been lodged in the peritoneal cavity. The distended bowel is decompressed through a nasogastric tube.

Bleeding from the small bowel: Small bowel bleeding is uncommon and is difficult to diagnose. It occurs predominantly due to abnormal blood vessels or arteriovenous malformations in the wall of the bowel. Often labeled as ‘obscure GI bleeding’ it can be slow chronic ooze or massive bleeding all of a sudden. This entity will require a variety of investigations like capsule endoscopy; enteroscopy and a nuclear scan to exactly localize the site of bleed which then has to be removed surgically.  If the cause is identified as AVMs, then they are cauterized with a small amount of electric current is passed through the endoscope.

Crohn’s Disease: Crohn’s disease is yet another condition of the small intestine seen more often these days than before, usually seen in young individuals with chronic diarrhea and weight loss. There are specific investigations available now to diagnose this condition with accuracy. Most of these patients will require long-term medical treatment. Some of them develop bowel obstruction, internal fistulae requiring repeated operations. The operative options for Crohn’s disease include internal bypass, external bypass, resection of the small bowel, anastomotic technique, laparoscopy and laparoscopic assisted procedure and strictureplasty.

Tumor: Tumors of the small bowel are either adenocarcinoma or lymphoma presenting with bleeding and or obstruction. These need to be excised with a wide margin. Gastro-intestinal stromal tumors are seen quite often in the small intestine requiring excising a segment of the involved bowel. Small bowel adenocarcinomas are essentially treated with resection – removal of the affected portion and rejoining of the small bowel, chemotherapy and radiotherapy.

Gangrene: A gangrenous bowel can be a life-threatening condition. This usually affects people above the age of 50. Sudden occlusion of the blood supply to the small intestine leading on to gangrene of the small bowel causes severe abdominal pain and distension. Emergency surgical resection of the gangrenous tissue is conducted along with antibiotic therapy. A new opening in the abdomen is created to allow waste to empty into a bag outside the body.

Small bowel obstruction: Incarceration in a hernia and trauma to the intestine are some of the other common conditions requiring surgery on the small intestine. Bowel obstruction can be functional or mechanical. The repair is conducted under general anesthesia. The area of blockage is identified and unblocked and damaged parts of the bowel are removed. The healthy ends are then reconnected and stapled.