Definition of Small Intestine
The small intestine is the part of the gastrointestinal tract that extends from the stomach to the large intestine (colon). It is about 22 feet long and functions mainly in digestion and absorption of food. It also secretes a number of hormones and has important immune functions.
Diseases of the Small Intestine
Most often patients with small bowel or small intestinal disease present with obstruction which means that something is blocking the channel so that fluid and gas cannot progress through the small intestine to the colon. This results in pain, bloating, abdominal distention, and ultimately in nausea and vomiting. The most common causes of obstruction are adhesions (scar tissue) usually from prior surgery, hernias, and malignancy. Inflammatory processes like Crohn’s disease can also be a cause.
When a patient presents with symptoms and signs suggestive of obstruction a good physical exam may detect a hernia of the abdominal wall suggesting trapped bowel. A CAT scan can show a malignancy or inflammation of a segment of bowel. The scan may also help determine what segment of bowel is involved. Finally the CAT scan may indicate whether the bowel has leaked or if it has compromised blood supply.
If nonsurgical measures such as nasogastric tube decompression, IV fluids and antibiotics do not allow resolution of the blockage then the patient will need surgical intervention. Commonly this can be done with a minimally invasive approach (laparoscopically). Scar tissue can usually be cut or divided so that the bowel obstruction is relieved without removing the involved segment of bowel. The same is true for hernias which can be repaired after the entrapped bowel is freed. Tumors (benign or malignant) and inflamed segments of bowel usually have to be resected or cut out. This also can sometimes be done laparoscopically. The advantage of the laparoscopic approach is less pain for the patient, quicker recovery, and avoidance of a large scar. In addition complications like pneumonia and blood clots are less common due to the patient’s ability to get up and ambulate as well as take deep breaths postoperatively.
After Small Bowel Surgery
- If the small bowel has been blocked for a few days or if a segment of bowel has been removed, then it may take 2-5 days before the function recovers enough for the patient to resume a regular diet.
- Usually the patient is up and walking within 24 hours of surgery to try to help restore bowel motility and to avoid complications like blood clots or pneumonia.
- Patients may shower in 24 hours and drive a car in 3-5 days.
- Laparoscopic incisions are closed with absorbable sutures that do not have to be removed.
- Patients can return to work in about 2 weeks for a desk job and 4-6 weeks for vigorous manual labor.