Large bowel surgery - Investigations and procedures

Large bowel surgery

Resection of the large bowel often requires temporary or permanent stoma to allow healing of the relatively fragile bowel. Patients require counselling wherever possible prior to surgery.

A stoma refers to the exteriorisation of any part of the bowel. These are subdivided into two categories:

1. Colostomy (exteriorisation of the colon), which is flush to the skin. Both ends may be exteriorised as a colostomy and a mucous fistula or the rectal stump can be closed off and left within the pelvis (Hartman’s procedure). Both procedures may be reversible.

2. Ileostomy, which requires the creation of a cuff of bowel to prevent skin damage as a result of the digestive enzymes.

In elective procedures such as resection of tumours bowel preparation is performed to clear the bowel of faeces prior to surgery. Prior to emergency surgery aggressive resuscitation is required. Resection of tumours, when of curative intent, involves removal of an adequate region of healthy bowel and as much as possible of the regional lymph drainage.

Complications of intestinal surgery include wound infection and anastomotic failure, the treatment for which is surgical drainage and exteriorisation.