Surgical Procedures: Small Bowel Resection

What is a small bowel resection?

A small bowel resection is a surgery done to remove the small intestine. It may be used to treat certain cancer and precancerous diagnoses, such as polyps. It may also be used in non-cancerous cases like: bleeding, infections or severe ulcers, conditions like Crohn’s disease, regional ileitis and regional enteritis, bowel obstruction, certain birth defects, and small intestine injury.

It may be done to take out all or part of the small intestine. The small intestine is a long tube with three parts:

• The duodenum is the first part of the small intestine. It joins the stomach to the small intestine and is where digestive enzymes enter the body.
• The jejunum is the middle part of the small intestine. It takes in nutrients and moves food through the bowel.
• The ileum is the last part, which joins the small and large intestines.

There are three types of small bowel resection, based on which part of the bowel is removed:

• Duodenectomy: The duodenum is removed.
• Jejunectomy: The jejunum is removed.
• Ileectomy: The ileum is removed.

How is a small bowel resection done?

There are different ways of doing a small bowel resection, such as laparoscopic (small incisions or cuts in the skin) and open procedures (a bigger incision or cut in the skin).

• During a laparoscopic small bowel resection, a probe with a lighted camera and other surgical tools are put into the belly through many small cuts.
• An open small bowel resection allows the surgeon to access the small bowel through a large belly incision.

An ileostomy (an opening to the outside of the body) may be needed for stool to exit the body after a small bowel resection. If an ileostomy is not needed, the parts of the bowel that are cut are reattached to each other so that bowel movements can happen.

The need for an ileostomy depends on if the surgeon can join the ends of the small bowel. If the ends can be reconnected, stitches or staples will be used to form an anastomosis (connection). At times this can't be done. In these cases, a temporary or permanent ileostomy is needed.

What are the risks of a small bowel resection?

There are risks and side effects related to having a small bowel resection. Risks and side effects may be:

• Reaction to anesthesia: Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to manage pain. Reactions can include wheezing, rash, swelling, and low blood pressure.
• Harm to nearby organs.
• Bleeding.
• Infection.
• Blood clots.
• Trouble breathing.
• Heart attack/stroke.
• Diarrhea.
• Abdominal (belly) abscess (collection of pus) and/or abdominal bleeding.
• Incisional hernia: When tissue in the belly pushes through the muscle where the incision is. It can look like a lump and can be painful or tender when touched.
• Adhesion/scar tissue formation: An adhesion is scar tissue that joins 2 pieces of tissue that should not be joined. They are often painless and do not need treatment. Serious cases can cause a blockage in the bowel or slowed blood flow.
• Bowel obstruction: This is a blockage in the bowel that can slow digestion or the removal of stool.
• Short bowel syndrome: Can lead to problems absorbing nutrients and vitamins.
• Anastomotic leaks: A leak in the area reconnecting the bowel that causes this fluid to leak into the body.
• Problems with the stoma, if an ileostomy was used: The stoma is the hole that the surgeon makes on your belly where stool comes out of and into a bag.
• Incision re-opening.

What is recovery like?

Recovery from a small bowel resection depends on the extent of the procedure. At times, a week long hospital stay is needed. During surgery, a urinary catheter and a nasogastric (NG) tube will be placed. The urinary catheter will drain pee into a collection bag outside of your body. The nasogastric tube will drain the contents of your stomach. You will not be able to eat in order to allow the bowel to heal. At times, IV (into a vein) nutrition may also be needed. These will be removed when you no longer need them.

You will be told how to care for your incisions and stoma (if you have one) and any other instructions before leaving the hospital. Full instructions on caring for your stoma will be given to you by a trained stoma nurse/therapist. Your medical team will talk to you about the medications you will be taking, such as those to prevent pain, blood clots, infection, constipation or other conditions.

Your provider will tell you what you should and should not do when you go home. This will often include:

• Avoid lifting anything over 10 pounds for 4 weeks, or until you are told that you can.
• No climbing and/or strenuous activity for 4-6 weeks, or until you are told that you can.
• Do not let your incision go under water in a tub or other body of water until you are told that you can.
• Change your diet as instructed; you may be asked to eat a low-residue diet for 4 weeks after surgery.
• Drink 8 to 10 glasses of water per day unless you are told not to.
• Don’t strain trying to have a bowel movement. Ask your provider about the use of a stool softener if needed.
• Don’t drive while taking narcotic pain medication.
• You may be able to return to work in 2-3 weeks, based on the type of surgery and your type of job.
• Speak with your provider about showering, getting your surgical incisions wet, diet recommendations, and sexual activity.

What will I need at home?

• Thermometer to check for fever, which can be a sign of infection.
• Loose clothes and underwear.
• Incision and stoma care supplies, often given to you by the hospital, your healthcare team or the stoma nurse/therapist.

When should I call my provider?

• Fever of 101°F (38.3°C).
• Drainage, bleeding, pain, redness, swelling, or warmth at your incision.
• Abdominal swelling, nausea, or vomiting.
• If you have not had a bowel movement for 4 days after you left the hospital or if you stop having bowel movements.
• Passing bowel movements that are bloody, black, or tarry (thick, black).
• Problems with ileostomy and/or if your ileostomy is not passing stool.
• Shortness of breath and/or chest pain.
• Leg swelling and/or calf pain.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection, and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.