Bowel resection

Definition

A bowel resection is a surgical procedure in which a part of the large or small intestine is removed.

Purpose

Bowel resection may be performed to treat various disorders of the intestine, including cancer, obstruction, inflammatory bowel disease, ruptured diverticulum, ischemia (compromised blood supply), or traumatic injury.

Description

The preferred type of bowel resection involves removal of the diseased portion of intestine, and surgically re-joining the remaining ends. In this procedure, the continuity of the bowel is maintained and normal passage of stool is preserved. When deemed necessary by the surgeon, the diseased portion of the bowel may be removed, and the functioning end of the intestine may be brought out onto the surface of the abdomen, forming an temporary or permanent ostomy. Use of the large intestine to form the ostomy results in a colostomy; use of small intestine to form the ostomy results in an ileostomy.

Preparation

As with any surgical procedure, the patient will be required to sign a consent form after the procedure is explained thoroughly. Blood and urine studies, along with various x rays and an electrocardiogram (EKG) may be ordered as the doctor deems necessary. In order to empty and cleanse the bowel, the patient may be placed on a low residue diet for several days prior to surgery. A liquid diet may be ordered for at least the day before surgery, with nothing taken by mouth after midnight. A series of enemas and/or oral preparations (GoLytely or Colyte), may be ordered to empty the bowel of stool. Oral anti-infectives (neomycin, erythromycin, or kanamycin sulfate) may be ordered to decrease bacteria in the intestine and help prevent post-operative infection. A nasogastric tube is inserted through the nose into the stomach on the day of surgery or during surgery. This removes the gastric secretions and prevents nausea and vomiting. A urinary catheter (thin tube inserted into the bladder) may also be inserted to keep the bladder empty during surgery, giving more space in the surgical field and decreasing chances of accidental injury.

Aftercare

Post-operative care for the patient who has had a bowel resection, as with those who have had any major surgery, involves monitoring of blood pressure, pulse, respirations, and temperature. Breathing tends to be shallow because of the effect of anesthesia and the patient's reluctance to breathe deeply and experience pain that is caused by the abdominal incision. The patient is instructed how to support the operative site during deep breathing and coughing, and is given pain medication as necessary. Fluid intake and output is measured, and the operative site is observed for color and amount of wound drainage. The nasogastric tube will remain in place, attached to low intermittent suction until bowel activity resumes. Fluids and electrolytes are infused intravenously until the patient's diet can gradually be resumed, beginning with liquids and advancing to a regular diet as tolerated. The patient is generally out of bed approximately eight to 24 hours after surgery. Postoperative weight loss follows almost all bowel resections. Weight and strength are slowly regained over a period of months.

Risks

Potential complications of this abdominal surgery include:

• excessive bleeding

• surgical wound infection

• incisional hernia (An organ projects through the muscle wall that surrounds it. The hernia occurs through the surgical scar.)

• thrombophlebitis (inflammation and blood clot to veins in the legs)

• pneumonia

• pulmonary embolism (blood clot or air bubble in the lungs' blood supply)

Normal results

Complete healing is expected without complications after bowel resection. The period of time required for recovery from the surgery may vary depending of the patient's overall health status prior to surgery.

Abnormal results

The doctor should be made aware of any of the following problems after surgery:

• increased pain, swelling, redness, drainage, or bleeding in the surgical area

• headache, muscle aches, dizziness, fever

• increased abdominal pain or swelling, constipation, nausea or vomiting, rectal bleeding, or black, tarry stools

Key Terms

Diverticulum

Small tubes or pouches that project off the wall of the intestine, visible as opaque on an x ray after the patient has swallowed a contrast (dye) substance.

Embolism

Blockage of a blood vessel by any small piece of material traveling in the blood. The emboli may be caused by germs, air, blood clots, or fat.

Ischemia

A compromise in blood supply to body tissues that causes tissue damage or death.

Ostomy

A surgically-created opening in the abdomen for elimination of waste products (urine or stool).

For Your Information

Books

• Doughty, Dorothy. Urinary and Fecal Incontinence. St. Louis: Mosby-Year Book, Inc., 1991.

• Hampton, Beverly, and Ruth Bryant. Ostomies and Continent Diversions. St. Louis: Mosby--Year Book, Inc., 1992.

• Monahan, Frances. Medical-Surgical Nursing. Philadelphia: W. B. Saunders Co., 1998.

• Suddarth, Doris. The Lippincott Manual of Nursing. Philadelphia: J. B. Lippincott, 1991.

• United Ostomy Association, Inc. (UOA). 19772 MacArthur Blvd., Suite 200, Irvine, CA 92612-2405. (800) 826-0826. http://www.uoa.org

• Wound Ostomy and Continence Nurses Society. 1550 South Coast Highway, Suite #201

Source: Gale Encyclopedia of Medicine, Published December, 2002 by the Gale Group

The Essay Author is Kathleen D. Wright RN.

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