Clinical Nutrition Topic of the Day: Small Bowel Resection

As part of a case study for my Mon General clinical rotation, I chose an elderly patient who had recent bowel resection surgery.  The patient had been having abdominal pains for the past two weeks.  The patient was permitted no food by mouth (NPO) until further notice and may need possible nutrition support (enteral/parenteral feeding) if the patient cannot tolerate food orally in the next couple of days.  So what is bowel resection surgery and what causes it? Here is some general information.

The purpose of small bowel resection surgery is to remove an area of the small intestine that is blocked or diseased.  The procedure can be performed lapar0scopically or an open surgery on any of the three sections of the small intestine: the duodenum, jejunum, or ileum. A small bowel resection is commonly used to surgically treat these types of conditions:

  • Crohn’s disease
  • Cancer
  • Ulcers
  • Intestinal obstruction or blockage
  • Bowel injuries or trauma
  • Precancerous polyp removal

The diseased or obstructed portion of the small intestine is removed.
Source: http://health.rush.edu/HealthInformation/cancer%20center/10/000118.aspx

The healthy segments of the small intestine are then reattached.

There are many concerns a dietitian may have after a patient undergoes a bowel resection.  The first concern is for the patient to gradually start eating post-surgery.  Due to the altered functioning of the GI tract, many people may experience discomfort after surgery including bloating, nausea, diarrhea, and even have a general fear of eating.  It is important for the dietitian to be realistic about the patient’s goals to gradually increase food intake depending on the severity of the patients surgery and current condition. Clear liquids can be introduced into the diet once the bowel is functioning again (signalled by the presence of bowel sounds or flatus).  The diet can be advanced based on the individual’s recovery process.  If the patient is not meeting their energy needs by oral intake of foods, enteral support may need to be initiated.  Some individuals may never be able to consume normal volumes of food and complete adaption of the GI tract can take up to one year post-surgery.

The small intestine is the site of much of the body’s nutrient absorption, with the majority of nutrient absorption in the first 100 cm. Thus, the dietitan next needs to address nutritional concerns of the patient.  Five factors need to be taken into account: (1) the length of the small bowel left, (2) the presence of the ileocecal valve, (3) which section of the small bowel is left, (4) age of the patient, and (5) the presence or absence of disease.  For the most part, the small intestine will compensate in terms of nutrient capacity for the section of intestine that was removed.  However, the jejunum is much more adaptive whereas removal of the ileum would most likely render a patient on lifelong parenteral nutrition, supplemental vitamin B12, and cause fat malabsorption.

Sources:

ADA Nutrition Care Manual

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