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Small Bowel Surgery
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.
The most common conditions leading on to small intestine surgery include
Small intestine is one of the common sites of tuberculosis in India. 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.
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.
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.
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.
Sudden occlusion of the blood supply to the small intestine leading on to gangrene of the small bowel causes severe abdominal pain and distension. This requires urgent accurate diagnosis and surgical removal of the damaged intestine.
Surgery for Familial polyposis coli:
Uncommon hereditary disease of the colon presenting with multiple polyps all over the colon. This condition has a high malignant potential hence will require complete removal of the colon and rectum. Bowel continuity is restored by performing an ileo-anal pouch.
Surgery for ulcerative colitis:
Ulcerative colitis is an inflammatory disease of the large bowel, which can vary in severity. It usually starts from the rectum and ascends towards the caecum. Most patients in India have a milder form of ulcerative colitis localized to the left colon and subsiding with oral medication.
Some of these patients present to the emergency ward with severe symptoms requiring hospitalization and sometimes surgery for conditions like toxic megacolon ,massive lower GI bleeding etc. Surgery will involve total colectomy with ileostomy.
Elective surgery for extensive ulcerartive colitis or pancolitis or cancer in a setting of ulcerative colitis will include removal of the entire colon and rectum called total procto-colectomy and the normal continuity is restored by creating an ileo-anal pouch.This procedure generally avoids an ielostomy.
Diverticulitis is a condition usually seen in the old where areas of weakness develop in the sigmoid and ascending colon resulting in localized ballooning of colonic mucosa called diverticulosis. Infection and inflammation of these diverticuli result in diverticulitis. This condition might require surgery if it presents with colonic obstruction , colo-vesical fistula or uncontrollable bleeding. Surgery will be in the form of resecting the involved segment and anastomosis.
Surgery for Cancer of Colon and rectum:
One of the commonest diseases of the colon and rectum, cancer can affect any part of the large bowel. Surgical removal of the cancer is the primary treatment modality. Rectal cancers will require complete removal of the rectal apparatus with a permanent end colostomy. In some of the rectal cancers the anal sphincter mechanism can be preserved by using surgical staplers. Cancers of the colon will require removal of a part of the colon clled Rght or Left hemi-colectomy