Some diseases and conditions of the colon and intestine are managed surgically, whereas others are managed with diet and lifestyle changes and medications. Many problems with the colon and intestine are “functional problems” affecting motility and absorption, which can result in bloating, pain, and altered bowel habits such as diarrhea or constipation. Functional problems of the colon are more commonly treated medically, by a primary doctor or gastroenterologist.
Other problems with the colon or intestine are “anatomic problems” such as masses, diverticula which can become infected, a twist causing blockage (called a volvulus), blockage from scar tissue in the abdomen, and ischemia, which is poor blood flow to the intestine or colon. Anatomic problems of the intestine or colon more commonly require surgery. The most common surgical conditions of the colon and intestine include cancers, infections, strictures or obstructions, and inflammatory conditions. At times these conditions result in acute illnesses requiring emergency surgery, and at others the conditions are more chronic in nature and can be worked up by your primary doctor and surgeon as an outpatient.
Evaluation and Diagnostic Tests
Diagnostic tests to identify colon and intestine problems may include:
- X-ray or CT scan
- Small bowel follow through study or barium enema study
- Fecal occult blood testing
- Lab analysis
If a surgically correctable problem is not identified in workup of your symptoms, a referral to a Gastroenterologist, a medical doctor of the GI tract, may be necessary.
Colon and Intestine Surgery
When surgery is required on the colon or intestine, typically a section of the bowel is removed. The ends are then re-connected by stapling them together in a way that creates a common lumen, or channel through which the fecal material passes. Patients are hospitalized after such surgeries until they are passing gas, moving their bowels, and eating and drinking normally. Recovery of bowel function can take a variable amount of time.
In some cases, particularly emergencies, reconnection of the pieces of bowel is not possible. Those situations require creation of an ostomy, which brings the end of either the intestine or colon through the abdominal wall. The open end of the intestine or colon is attached to the skin to create an ileostomy (small intestine) or colostomy (colon). Fecal material is collected in a bag for disposal. If an ostomy is necessary, often it is temporary while healing from the underlying problem occurs. After an appropriate period of healing, the ostomy can then be “reversed,” which reconnects the ends of the colon or intestine so the GI tract is in continuity. In rare instances, an ostomy may be permanent. There are specially trained nurses called Ostomy Nurses who assist patients with their ostomy and help them learn to care for it independently. Fortunately, most intestine and colon surgeries do not require an ostomy.
Preparing for Surgery
Your doctor has referred you to Montrose Surgical Associates because we are specialists who perform surgeries on the colon and intestine.
Your MSA surgeon will take a history of your symptoms, perform a physical exam, and discuss whether further diagnostic tests are needed. You will have a chance to discuss options, have your questions answered, and learn what to expect for your surgery and recovery. This may occur in a single consultation or may occur over multiple visits. You will get to know your surgeon and become comfortable with plans for your care.
If it is decided that you need surgery, you will receive detailed instructions to prepare yourself for the surgery, including specific diet restrictions in the days leading up to surgery. A bowel prep to evacuate the fecal contents is typically necessary for colon surgery, but not for small intestine surgery.
While colon and intestine surgery is safe, as with all surgeries, there are some risks, which include:
- Infection or bleeding
- Leakage at the bowel reconnection
- Stricture at the reconnection
- Hernia formation at the incision site
- Injury to other intra-abdominal structures around the colon or intestine