From the Guidelines
After a small bowel resection, it is crucial to closely monitor for signs of complications, including infection, bowel obstruction, anastomotic leak, and short bowel syndrome, as well as assess nutritional status and bowel function return, to prevent morbidity, mortality, and improve quality of life. The monitoring steps should include watching for adequate bowel function return, indicated by passing gas and having bowel movements, and monitoring fluid and electrolyte balance, as dehydration can occur due to diarrhea or inadequate oral intake 1. Nutritional status should be assessed regularly, as malabsorption may occur depending on which section and how much bowel was removed, and some patients may require vitamin B12 supplementation if the terminal ileum was resected 1. Pain should be managed with prescribed medications like acetaminophen or opioids as directed, and dietary recommendations should be followed, typically starting with clear liquids and gradually advancing to solid foods as tolerated 1. Long-term, it is essential to be vigilant for signs of malnutrition, vitamin deficiencies, and changes in bowel habits, as the small intestine is responsible for nutrient absorption, and resection can impact digestive function and nutritional status depending on the extent and location of the removed segment 1. Key points to monitor post small bowel resection include:
- Infection (fever, redness or drainage at the incision site)
- Bowel obstruction (severe abdominal pain, vomiting, abdominal distension)
- Anastomotic leak (fever, severe abdominal pain, peritonitis)
- Short bowel syndrome (chronic diarrhea, malnutrition, dehydration)
- Adequate bowel function return (passing gas and having bowel movements)
- Fluid and electrolyte balance
- Nutritional status
- Pain management
- Dietary recommendations
- Long-term monitoring for malnutrition, vitamin deficiencies, and changes in bowel habits.
From the Research
Postoperative Complications
- Nausea, vomiting, bloating, delayed passage of flatus and stools, and inability to tolerate solid food are common symptoms after bowel resection with anastomosis 2
- Patients who undergo small bowel resection may experience a shorter recovery time compared to those who undergo right or left colon resection 2
Recovery Time
- Solid foods are typically tolerated after a median of 3 hours after small bowel resection, and medians of approximately 16 and 14 hours after right and left colon resection, respectively 2
- The first flatus appears approximately 16,44, and 17 hours after resection of the small bowel, right colon, and left colon, respectively 2
- The first stool appears approximately 36,70, and 46 hours after small bowel, right colon, and left colon resection, respectively 2
Risk Factors for Adverse Outcomes
- Disseminated malignancy, older age, American Society of Anesthesiologists IV/V, cirrhosis, ascites, urinary tract infection, sepsis, albumin <3.5, hematocrit <30, and bowel resection are factors independently associated with mortality after surgery for bowel obstruction 3
- Dirty or infected wounds, ASA class 4 or 5, age >80 years, and dyspnea at rest are risk factors for adverse outcomes after surgery for small bowel obstruction 4
Non-Inflammatory Small Bowel Obstruction
- Active macroscopic or microscopic inflammation in the surgical margins, open resection, and a higher median number of previous resections are variables associated with the development of non-inflammatory small bowel obstruction (NI-SBO) after small bowel resection in Crohn's disease patients 5
- The incidence of NI-SBO after small bowel resection in Crohn's disease is low, and most NI-SBOs resolve with medical management 5