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- National Institutes of Health: Colorectal Cancer
- National Institutes of Health: Small Bowel Resection
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Bowel Complications After Surgery
Colon cancer and small bowel obstruction are two common reasons for surgery in the abdomen. Colon cancer is the fourth most common cancer in the United States, according to the National Institutes of Health 13. Small bowel obstruction is a blockage in the small intestine that prevents passage of the contents of the small bowel. Complications resulting from surgery include ileus, anastomotic leak and GI bleed.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
Ileus
An ileus is described by “Sabiston’s Textbook of Surgery” as distension of the small bowel and a loss of the normal peristalsis that moves the contents forward. Peristalsis is the wavelike contraction that normally occurs in the small bowel and colon to move contents along the digestive tract. Normally after surgery, normal function of the bowel returns in approximately 24 to 72 hours. An ileus occurs because of drugs, metabolic disorders, neurological problems and infections. Narcotics slow peristalsis of the small and large bowel. Constipation of the large bowel is common in patients taking narcotics. An ileus of the small bowel is not uncommon in hospitalized patients taking pain medicine. Derangements of the natural chemicals of the body after surgery can lead to an ileus. If the magnesium, sodium or potassium that naturally occurs is low, there is a potential for an interruption of peristalsis. The body needs an adequate supply of these chemicals to maintain active contractions of the digestive system. Patients with spinal cord injuries can have neurological reasons for an ileus, and pneumonia or a sepsis infection can cause an ileus.
- An ileus is described by “Sabiston’s Textbook of Surgery” as distension of the small bowel and a loss of the normal peristalsis that moves the contents forward.
Anastomotic Leak
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An anastomosis is the sewing together of two sections of bowel that have been resected. A leak occurs when the two ends separate. This allows bowel contents to leak into the stomach. Resections of the rectal colon are at high risk for leakage, according to Sabiston. The circulation to this area of the bowel is not as profuse as other areas and may compromise the tissue making up the anastomosis. Obesity is an independent risk factor for increased anastomotic leaks. Steroids affect healing by decreasing the availability of necessary healing factors and can cause leaks.
- An anastomosis is the sewing together of two sections of bowel that have been resected.
- Resections of the rectal colon are at high risk for leakage, according to Sabiston.
GI Bleed
Significant gastrointestinal bleeding secondary to a stess ulceration occurs in less than 5 percent of cases, according to Sabiston. A stress ulcer occurs when a patient has had major surgery and cannot eat. The stomach continues to produce acid in large quantities due to stress and can eat a hole into the lining of the stomach, which will bleed. Patients who have a GI bleed and who have low blood pressure, require blood transfusion and also re-operation for the bleed, have the highest associated rate of mortality.
- Significant gastrointestinal bleeding secondary to a stess ulceration occurs in less than 5 percent of cases, according to Sabiston.
- The stomach continues to produce acid in large quantities due to stress and can eat a hole into the lining of the stomach, which will bleed.
Related Articles
References
- National Institutes of Health: Colorectal Cancer
- “Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice”; Courtney Townsend, MD and et al.; 2008
- National Institutes of Health: Small Bowel Resection
- Vilz TO, Stoffels B, Strassburg C, Schild HH, Kalff JC. Ileus in Adults. Dtsch Arztebl Int. 2017;114(29-30):508–518. doi:10.3238/arztebl.2017.0508
- Zeinali F, Stulberg JJ, Delaney CP. Pharmacological management of postoperative ileus. Can J Surg. 2009;52(2):153–157. PMID: 19399212
- Carroll J, Alavi K. Pathogenesis and management of postoperative ileus. Clin Colon Rectal Surg. 2009;22(1):47–50. doi:10.1055/s-0029-1202886
- National Institutes of Health. "Intestinal pseudo-obstruction." National Institute of Diabetes and Digestive and Kidney Diseases. Feb 2014.
- Nghia, "Jack" Vo, MD, et al. Intussusception in children. UpToDate. Aug 27, 2019.
- Ansari P. “Ileus." Merck Manual Professional Version. Jan 2017.
Writer Bio
Catherine Schaffer has been writing since 1990. Her articles have appeared in many medical journals and textbooks. Schaffer holds a Bachelor of Science from Baylor College of Medicine and a physician assistant certificate. She has written health and nutrition articles for various websites and teaches movement and nutrition to help women overcome chronic diseases and obesity.