Overview
What Is It ?
The bowel is a tube of intestine which runs from the stomach to the back passage. It is much longer than the inside of your belly (tummy). It fits in by coiling up in loops. The upper part of the bowel is called the small bowel. It joins the lower part of the bowel (the colon) just to the right of the waistline.
This is where the appendix pouches out from the colon. The colon runs up to the right ribs and loops across the upper part of the belly. Then it passes down the left side to run backwards into the pelvis (the lower part of your abdomen) towards the back passage, where it is called the rectum. If most of the colon is diseased it can cause diarrhoea, bleeding or general illness which can potentially be life-threatening. It is better removed.
Sometimes the ends can be joined up inside your tummy. More often, the back passage is not healthy enough to make a safe join. Then the lowest part of the small bowel is brought out as a sort of spout (ileostomy) on the right side of the tummy. This looks like a big nipple of pink bowel stuck to the tummy skin. The bowel waste runs into a special bag stuck over the ileostomy.
The Operation
You will have a general anaesthetic, and will be asleep for the whole operation. A cut is made in the skin in the middle lower part of your abdomen and is about 25 cm (10 inches) long. The colon is freed inside your tummy. The diseased bowel is taken out. The lower end of remaining bowel is stitched shut. The upper end is made to open as an ileostomy. The wound in the tummy is stitched up. You should plan to leave hospital two weeks or so after the operation.
Reasons For Procedure
A colectomy may be performed to treat a variety of conditions, including the following:
- Colorectal cancer
- Inflammatory intestinal diseases (eg, colitis, Crohn’s disease)
- Intestinal blockage
- Trauma to the intestine
- Diverticular disease—small pouches form in the wall of the colon
- Precancerous polyps, especially those seen in familial polyposis
- A hole in the bowel wall, or dead piece of bowel
- Bleeding from the colon
Possible Complications
If you are planning to have a colectomy, your doctor will review a list of possible complications, which may include:
- Damage to other organs or structures
- Infection
- Bleeding
- Hernia forming at the incision site
- Blood clots
- Complications from general anesthesia
Factors that may increase the risk of complications include:
- Having neurological, heart, or lung conditions
- Age: older than 70 years
- Obesity
- Smoking
- Previous abdominal surgery
- Active infection
Before - The Operation
Stop smoking and try to get your weight down if you are overweight. If you know that you have problems with your blood pressure, heart, or lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT).
Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to the hospital with you. On the ward, you will be checked for past illnesses and will have special tests, to make sure that you are well prepared and that you can have the operation as safely as possible. .
Please tell the doctors and the nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form. Before you sign the consent form, make sure that you fully understand all the information that was given to you regarding your health problems, the possible and proposed treatments and any potential risks. Feel free to ask more questions if things are not entirely clear. Many hospitals now run special preadmission clinics, where you visit a week or so before the operation, where these checks will be made.
After - In Hospital
You will have a fine thin plastic drip tube in an arm vein connected to a plastic bag on a stand containing a salt solution or blood. You may have a fine plastic tube coming out of your nose and connected to another plastic bag to drain your stomach. This is to decompress your stomach which, along with the bowel, may feel sluggish after an operation. Swallowing may be a little uncomfortable.
You will have a dressing on your wound and a drainage tube nearby, connected to yet another plastic bag. This drains any residual blood from the operation. You may have a fine rubber tube (catheter) passing into the bladder through the front passage. This lets the bladder stay empty and small during the operation and helps control your body fluids afterwards.
A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you can do things for yourself. Do not make important decisions during this time. You will be most likely able to get out of bed with the help of the nurses the day after the operation despite some discomfort.
After - At Home
You are likely to feel very tired and need to rest two or three times a day for a month or more. You will gradually improve so that by the time three months have passed you will be able to return completely to your usual level of activity. You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about three weeks. You can restart sexual relations within two or three weeks when the wound is comfortable enough. Sometimes the operation affects the sex nerves. This will be discussed with you. You should be able to return to a light job after about six weeks and any heavy job within 12 weeks.
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