Small bowel surgery
Small bowel resection is normally followed by immediate end-to-end anastomosis as the small bowel has a plentiful blood supply, a stronger wall and a content with a lower bacterial count. Small to medium resections have little functional consequence as there is a relative functional reserve; however, massive resections may result in malabsorption.
· Gastric hypersecretion is common postresection possibly due to loss of secretary inhibitory factors.
· Nutritional consequences are severe when more than 75% of the bowel is resected.
· Loss of jejunum affects all nutrients, loss of the terminal ileum affects absorption of bile salts and vitamin B12. Iron and folate are absorbed from the upper small bowel.
· Severe diarrhoea causes electrolyte loss, hypertrophy of the mucosa occurs over a period of 2 years after which any residual diarrhoea is likely to be permanent.
Following small bowel surgery fluid and electrolytes must be monitored and corrected as required, fat-soluble vitamins should be supplemented.