Introduction:
The small bowel, also known as the small intestine, is a significant organ for sustaining adequate health of the digestive system. It absorbs nutrients and the liquid that we eat. They also pass fecal products to the large intestine.
Difficulties with these procedures can lead to health hazards. In those cases, the operation is to extract an impaired area of small intestines. This procedure is mainly done for intestinal obstructions or other bowel disorders. This procedure is known as small bowel resection.
Small bowel resection is a generally accomplished operation in the general surgery branch. In most cases, the small intestine measurement permits uncomplicated resection without causing significant complications to the gastrointestinal system's functioning. Understanding the anatomy of the bowel and the measures required to execute a safe surgery are essential elements of practicum.
What Is Small Bowel Resection?
A small bowel resection is a surgical procedure to extract the small intestine. It is done to manage specific cancer and detect it in a precancerous diagnosis procedure involving polyps. It is also utilized in non-cancerous conditions like blood loss, infections, ulcers, diseases involving Crohn's disease, regional ileitis, regional enteritis, bowel blocks, birth faults, and small bowel damage. It is accomplished by removing the whole or portion of the small bowel.
The small intestine has three parts:
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The first portion is called the duodenum. It connects the abdomen to the small intestine, the site where digestion enzymes penetrate the body.
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The second portion is called the jejunum, the small intestine's central portion. It carries in nutrients and forces food through the intestine.
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The last portion is the ileum, which binds the small and large intestines.
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Small bowel resections are three types. It depends on the portion of the empty bowel. They are:
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Duodenectomy- This is a procedure in which the duodenum is extracted.
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Jejunectomy- This is a procedure in which the jejunum is extracted.
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Ileectomy- This is a procedure in which the ileum is extracted.
What Are the Anatomic and Physiologic Considerations in Small Bowel Resection?
The small bowel consists of portions: duodenum, jejunum, and ileum. The duodenum double blood supply reaches from the celiac axis and superior mesenteric artery. The gastroduodenal artery from the celiac axis splits into the front top and back area superiorly pancreaticoduodenal arteries that extend the front and back portion of the duodenum and the head of the pancreas.
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The duodenum is divided into four parts. The foremost part is the duodenal bulb. The second is the ampulla of Vater and the Santorini duct. The third is the transverse duodenum. The ligament of Treitz, a muscular band, joins the duodenum and jejunum to the adjacent connective tissue.
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The jejunum is the second part of the small intestine. It is a hundred centimeters long and has a long vasa recta supplying blood. The jejunum is the area for nutrient absorption done maximally.
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The ileum is the last part of the small intestine.
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The blood supply for the jejunum and ileum arrives from multiple departments from the superior mesenteric artery. The terminal ileum and cecum acquire blood supply from the ileocolic artery.
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The surgical anatomy of the small intestine can be separated into three layers: mucosa, muscular, and serosa.
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The layer banding the lumen of the bowel is the mucosa.
What Are the Indications of Small Bowel Resection?
There are numerous indications for small bowel resection. The principles of small bowel resection are versatile. Modifications of the surgical method may be demanded based on pathology.
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Block that cannot be easily managed.
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Suspected cancers.
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Non-traumatic perforation, like ulcerative disease and malignancy.
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Traumatic perforation, like defects, can be fixed if it encloses fifty percent of the small bowel loop.
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Ischemic necrosis appears secondary to an embolus and thrombus.
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Inflammatory bowel disease in which resection is generally the final option of treatment.
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Enteocutaneous fistula is not curable with conservative methods.
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Necrotizing enterocolitis with penetration.
What Are the Contraindications of Small Bowel Resection?
There are no definitive contraindications for all populations. Functional inflammatory bowel disorder is a relative contraindication. It's because regional inflammation raises anastomotic leak risk. Relative contraindications also occur as the small bowel resection is supposed to extract the affected part without additional therapeutic choices.
How Is Small Bowel Resection Procedure Performed?
Small bowel resection is done in an open procedure setup or laparoscopic approach. It is based on the timing and manifestation of the procedure. For resections, bowel preparation is done with a low detritus diet for some periods before the surgery is typically launched. Automated bowel preparation is counted, but it is not common. Circumstances that require small bowel reactions are emergent, and thus the preoperative assessment is restricted to supportive supervision for the terminating ill cases.
The preparation methods are suggested to reduce the postoperative difficulties with small bowel resection, such as estimating the nutritional situation and abdominopelvic abscess removal, in established requirements, like Crohn's disease.
Laparoscopic Surgery- During a laparoscopy, the surgeon creates three to five incisions in the belly. They are then followed by penetrating a device known as a laparoscope via the incision. The laparoscope is a tube that has a light with a camera on its end. It enables a better vision for the surgeon. Other tools are inserted via the further incision. An incision of around three inches also is created to place their hand inside your abdomen to sense the intestine. The abdomen is refilled with gas to inflate it. The affected portion of the small bowel is found and cleared.
Open Surgery- An incision of around six to eight inches is created on the middle part of the belly, followed by the extraction of the affected part of the small bowel.
Conclusion:
Small bowel resection is accomplished for multiple causes. A general surgeon executes the surgical procedure. Thus, a small bowel disease case workup involves an interprofessional group involving a radiologist, pathologist, gastroenterologist, and nurse. Patients should be familiarized with the complications of this procedure, including leakage of bowel strictures, deep vein thrombosis, blemish, and infections. Before the commencement of the procedure, the patient should be notified about the necessity for bowel preparation.
