Causes of Small Bowel Resection

Small bowel resection is a surgical procedure in which a portion of the small intestine is removed. This may be necessary due to various medical conditions that affect the health and function of the small intestine. Although it is a major surgery, small bowel resection can be life saving or significantly improve the patient’s quality of life by removing diseased or damaged sections of the bowel. Understanding the causes behind this surgery helps patients prepare mentally and emotionally, and allows them to make informed decisions about their treatment plan.

While the idea of removing part of the intestine might sound alarming, it’s important to understand that small bowel resection is often a carefully considered and necessary step to restore normal digestive function or eliminate serious health risks. The procedure is used to treat a wide range of conditions from chronic inflammatory diseases like Crohn’s, to emergencies such as bowel obstruction or mesenteric ischemia.

What is Small Bowel Resection?

The small bowel, or small intestine, is a long, coiled tube that connects the stomach to the large intestine. It is responsible for digesting food and absorbing nutrients. The small bowel has three parts: the duodenum, jejunum, and ileum. Any disease, trauma, or obstruction affecting these sections can disrupt digestion and nutrient absorption, leading to serious complications if left untreated.

When part of the small bowel becomes diseased or damaged beyond repair, surgical removal through small bowel resection may become necessary.

Causes of Small Bowel Resection

1. Bowel Obstruction :- One of the most frequent causes of small bowel resection is bowel obstruction. An obstruction occurs when something blocks the passage of food, fluids, or gas through the small intestine. This can be caused by scar tissue (adhesions), hernias, tumors, or strictures due to inflammation.

   While some obstructions can be treated with non-surgical methods such as nasogastric decompression or intravenous fluids, more severe or persistent blockages may require surgical intervention. If a portion of the bowel becomes necrotic (dead tissue) due to a lack of blood supply or pressure from the blockage, that section must be removed to prevent further complications such as infection or sepsis.

2. Crohn’s Disease :- Crohn’s disease is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract, but it often involves the small intestine. In Crohn’s, the inflammation can cause sections of the bowel to become narrowed, scarred, or ulcerated. This can lead to chronic pain, poor absorption of nutrients, bowel obstruction, and fistulas.

   When medical management with medications such as steroids, immunosuppressants, or biologics fails to control symptoms, or when complications like strictures or perforations occur, small bowel resection may be recommended. The goal is to remove the diseased segment and restore bowel continuity and function.

3. Cancer of the Small Intestine :- Although relatively rare, cancers can develop in the small intestine. These include adenocarcinoma, lymphoma, carcinoid tumors, and gastrointestinal stromal tumors (GISTs). Malignant tumors can cause bleeding, obstruction, or perforation of the bowel.

   Surgical resection is often the primary treatment for small bowel cancer, particularly in early-stage or localized tumors. During the procedure, the surgeon removes the tumor along with a margin of healthy tissue and associated lymph nodes to prevent recurrence and allow for accurate staging.

4. Injury or Trauma to the Abdomen :- Blunt force trauma (from accidents or falls), penetrating injuries (such as stab or gunshot wounds), or surgical complications may severely damage parts of the small intestine. If the injury compromises the blood supply or integrity of the intestinal wall, resection becomes necessary to remove the damaged segment and prevent complications such as peritonitis or septic shock.

   Emergency small bowel resection is often performed in trauma centers as part of life-saving surgery following abdominal injuries.

5. Ischemia or Lack of Blood Supply (Mesenteric Ischemia) :- The small bowel is highly sensitive to interruptions in blood supply. When blood flow to the intestine is reduced or completely blocked often due to blood clots (embolism), atherosclerosis, or low blood pressure the tissue can become ischemic and start to die. This condition is known as acute mesenteric ischemia, a medical emergency that demands prompt treatment.

   If the affected bowel tissue becomes necrotic, it must be removed surgically. Delaying treatment can result in widespread infection, organ failure, and even death. In some cases, chronic mesenteric ischemia may also require bowel resection if it leads to progressive bowel damage.

6. Congenital Abnormalities :- In infants and children, certain birth defects may necessitate a small bowel resection. Conditions like intestinal atresia (where part of the intestine is missing or closed) or malrotation with volvulus (twisting of the intestine) can disrupt the normal flow of food and threaten the child’s life.

   Prompt surgical intervention, including resection of non functional or twisted segments of the bowel, helps restore intestinal continuity and prevent long term complications like short bowel syndrome.

7. Radiation Enteritis :- Patients who undergo radiation therapy for abdominal or pelvic cancers may develop radiation enteritis, a condition where the bowel becomes inflamed and damaged due to exposure to radiation. In severe or chronic cases, this can lead to fibrosis, strictures, or ulceration of the bowel.

   When symptoms such as pain, obstruction, or bleeding cannot be controlled with medication or dietary changes, small bowel resection may be the only option to relieve symptoms and improve the patient’s quality of life.

8. Diverticulitis of the Small Intestine :- Although more common in the large intestine, diverticulitis can also occur in the small bowel, particularly in the jejunum. Diverticulitis involves inflammation or infection of small pouches (diverticula) that form in the intestinal wall.

   Complications such as abscesses, perforation, or obstruction may arise, necessitating surgical removal of the affected segment.

Conclusion

Small bowel resection is a major surgical intervention that becomes necessary when the integrity, function, or viability of the small intestine is compromised. From chronic inflammatory conditions like Crohn’s disease to life threatening situations such as bowel obstruction or mesenteric ischemia, there are a variety of reasons why doctors may recommend this procedure.