Small Intestine

The small intestine is the part of the digestive tract that is between the duodenum and the large bowel (colon). This is the part off the digestive tract that most of the digestion takes place. The small bowel is involved in several disease processes, but here we will discuss just two, because these can be treated with an operation.

Adhesions may develop after essentially any operation, or intra-abdominal inflammation, or infection. The more extensive the operation, or the more severe the infection, the more extensive the development of adhesions. Adhesions are abnormal connections between parts of the bowel, or between the bowel and the abdominal wall. These abnormal connections may present a problem, or actually inhibit the bowel contraction and propagation of bowel content through. This may lead to an increased effort of the bowel to overcome this inhibition by overcontracting, and this is the cause of colic pains. When adhesion formation is very extensive and dense, inhibition of bowel motility may not be able to overcome by increased bowel contraction. This is then complete bowel obstruction and needs an operation to fix. Bowel obstruction because of adhesions may occur in 3-5% of patients who have undergone an abdominal operation. Usually it is “incomplete” and it can resolve spontaneously. In a minority of patients however (as discussed above), it may not resolve, but need an emergency operation. In carefully selected patients, one may consider laparoscopic lysis of adhesions. We have done so in selected patients with bowel obstruction and we have published our experience. If the patientsʼ abdomen is not very distended and pneumoperitoneum can be safely established, then a laparoscopic approach should not be rule out.

Diverticulosis of the small bowel is far less common than the diverticulosis of the colon. Patients with small bowel diverticulosis may complain of frequent, indeterminate abdominal pain, bloating, and/or diarrhea. Because this condition is very rare, physicians tend not to think about it and they often treat such patients as if they had irritable bowel syndrome, or “dyspepsia”. It is even more rare that small bowel diverticula may cause bleeding or perforation and peritonitis. Most often the treatment of choice is well selected antibiotics, but there are patients who benefit from an operation. It is worth emphasizing that the most difficult problem in this disease is to recognize it because it is so uncommon.