Patient education: Small bowel resection (The Basics)

What is a small bowel resection? — 

This is surgery to remove part or all of the small bowel. The small bowel is also called the "small intestine." It connects the stomach to the large intestine (figure 1).

Doctors might do a small bowel resection to treat problems such as:

●Cancer or polyps

●Bleeding

●Digestive tract disorders, such as severe diverticulitis or inflammatory bowel disease

●A leak (hole) or blockage in the bowel

●An injury to the bowel

●Scar tissue that traps or blocks the bowel

The surgery can be done in 2 ways:

●Open surgery – The doctor makes a cut, or "incision," in the skin. This lets them see directly inside the body.

●Minimally invasive surgery – The doctor makes smaller incisions in the skin. They insert long, thin tools through the incisions. One of the tools has a camera (called a "laparoscope") on the end, which sends pictures to a TV screen. The doctor can look at the screen to see inside the belly. Then, they use the long tools to do the surgery. They can control the tools directly or with the help of a robot (called "robot-assisted" surgery).

You might be able to return to normal activities sooner if you had minimally invasive surgery than if you had an open surgery.

How do I prepare for small bowel resection? — 

The doctor or nurse will tell you if you need to do anything special to prepare.

Before the procedure, your doctor will do an exam. They might send you to get tests, such as:

●Blood tests

●X-rays, CT scan, or other imaging tests – These create pictures of the inside of the body.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before surgery – You might need to "fast" before surgery. This means not eating or drinking anything for a period of time. Or you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure.

●Medicines to take before surgery – You will get medicine to empty your intestines (called "bowel prep"). You might also need to take antibiotics the night before surgery to prevent infection. Follow your doctor's instructions on when and how to take these medicines.

●Lowering the risk of infection – You might need to trim (not shave) your body hair before the procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during small bowel resection? — 

When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get general anesthesia medicine. This makes you unconscious so you can't feel, see, or hear anything during surgery. You might get a breathing tube to help you breathe.

●The doctor will put a small tube in your mouth or nose during surgery. This tube goes down to your stomach to drain out any food or fluid. This is usually taken out when the surgery is done.

●They might put a thin, flexible tube called a "catheter" into your bladder. This drains urine during surgery. This is usually left in your bladder overnight and removed the next morning.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during surgery.

●The doctor will remove some or all of your small intestine. How much they remove depends on why you need surgery and how severe your condition is.

●They will make sure there is a way for bowel movements to exit your body. To do this, they will either:

•Reconnect your intestine – In most cases, your doctor can reconnect your intestine, and you can have bowel movements normally.

•Create an "ileostomy" – If your intestine cannot be reconnected (which is rare), the doctor will make a small hole in your belly. Then, they will connect your intestine to this opening. This is called an "ileostomy." Your bowel movements will come out through the hole into a bag that is attached to your skin (figure 2). The other end of your intestine might be connected to your skin. If it is at the same place as the ileostomy, it is called a "loop ileostomy." If it is connected to your skin at a different place, it is called a "mucus fistula."

●The doctor will close your incisions and cover them with clean bandages.

●The surgery usually takes 1 to 2 hours.

What happens after small bowel resection? — 

You will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Most people stay in the hospital for 3 to 5 days.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●You might have a sore throat from the breathing tube. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●Most people who do not have intestinal blockage can drink liquids within 1 to 2 days after surgery and eat solid foods soon after that. If you still cannot eat or drink after a week, your doctor might need to give you nutrition through an IV until you can eat again.

●Foods and liquids will pass through your body more quickly if a lot of your small intestine is taken out. This can affect how your body digests food and absorbs medicine.

●If you had minimally invasive surgery, you might have shoulder pain the next day. This is from the gas the doctor put into your belly.

What are the risks of small bowel resection? — 

Your doctor will talk to you about all the possible risks, and answer your questions. Possible risks include:

●Bleeding from the incision, small intestine, or belly

●Infection (in the incision, in the belly, or somewhere else)

●Blockage or narrowing of the remaining part of the small intestine or colon

●Leakage where the intestine is reconnected

●Short bowel syndrome – This is a condition where you have trouble absorbing nutrition from the food you eat because you have no or very little small intestine left.

●Damage to nearby organs like the liver or pancreas

●Blood clot in the leg or lung

●Frequent diarrhea

How do I care for an ileostomy? — 

If you have an ileostomy, a special ostomy nurse will teach you how to care for it. They will teach you when and how to change the bag that collects your bowel movements.

Many people have an ileostomy for a short time while their body heals after surgery, especially if they had surgery in an emergency. Most people do not need to have an ileostomy for the rest of their life.

If you need an ileostomy for only a short time, your doctor will do another surgery later to reconnect your small intestine. Then, you can have bowel movements normally again.

What else should I know? — 

Before you go home, make sure you know what problems to look out for and when to call the doctor. Make sure you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Small bowel resection – Discharge instructions (The Basics)
Patient education: Colon and rectal cancer (The Basics)
Patient education: Colon polyps (The Basics)
Patient education: Diverticulitis (The Basics)
Patient education: Ulcerative colitis in adults (The Basics)
Patient education: Ulcerative colitis in children (The Basics)
Patient education: Crohn disease in adults (The Basics)
Patient education: Crohn disease in children (The Basics)
Patient education: Newborn necrotizing enterocolitis (The Basics)
Patient education: Colostomy or ileostomy surgery (The Basics)
Patient education: How to care for an ostomy (The Basics)
Patient education: Living with an ileostomy (The Basics)
Patient education: Ileostomy diet (The Basics)
Patient education: Colostomy or ileostomy reversal (The Basics)

Patient education: Colon and rectal cancer (Beyond the Basics)
Patient education: Colon polyps (Beyond the Basics)
Patient education: Ulcerative colitis (Beyond the Basics)
Patient education: Crohn disease (Beyond the Basics)