From the Guidelines
For a patient with intestinal obstruction due to a small segment stricture of the terminal ileum located 2-3 cm from the ileocecal valve, the recommended operation is resection and anastomosis. This approach is based on the most recent and highest quality evidence available, which suggests that resection and primary anastomosis is a safe and effective treatment for small bowel obstruction due to stricture 1. The key considerations in this approach include:
- Removing the affected segment of the terminal ileum to eliminate the underlying pathology
- Ensuring adequate margins of healthy tissue to prevent recurrence
- Preserving as much bowel length as possible to minimize the risk of short bowel syndrome
- Performing primary anastomosis in an end-to-end or side-to-side fashion, depending on the surgeon's preference and anatomical considerations. While strictureplasty is a viable option for treating small-bowel strictures, particularly in patients with Crohn's disease 1, the proximity of the stricture to the ileocecal valve in this case makes resection and anastomosis a more suitable choice. The benefits of this approach include:
- Complete elimination of the underlying pathology
- Minimization of the risk of short bowel syndrome
- Preservation of intestinal function
- Reduced risk of surgical recurrence rates. Overall, resection and anastomosis is the recommended operation for a patient with intestinal obstruction due to a small segment stricture of the terminal ileum located 2-3 cm from the ileocecal valve, based on the most recent and highest quality evidence available 1.
From the Research
Surgical Options for Intestinal Obstruction
The patient's condition, characterized by a small segment stricture of the terminal ileum located 2-3 cm from the ileocecal valve, presents a challenge in terms of surgical management. The goal is to relieve the obstruction while preserving as much intestinal function as possible.
Considerations for Surgical Intervention
- The location and nature of the stricture are critical in determining the best surgical approach.
- The presence of intestinal obstruction due to the stricture necessitates a procedure that can effectively relieve the blockage.
- The patient's overall condition and potential for future complications must be considered when choosing a surgical method.
Potential Surgical Procedures
- Resection and Anastomosis: This involves removing the affected segment of the intestine and reconnecting the remaining portions. It is a common approach for treating intestinal obstructions due to strictures 2.
- Stricturoplasty: A procedure that involves making a longitudinal incision in the stricture and then closing it in a transverse fashion to widen the intestinal lumen. It is particularly useful for patients with Crohn's disease 2.
- Ileocecal Resection: This procedure involves removing the terminal ileum and a portion of the cecum. It may be considered for patients with complications such as abscesses or fistulas 3.
- Ileocecal Resection & Ileostomy: A temporary ileostomy may be created to allow the patient to recover before a subsequent procedure to reconnect the intestine.
Recommendations Based on Available Evidence
Given the patient's condition, with a small segment stricture of the terminal ileum causing intestinal obstruction, the most appropriate surgical option would likely be Resection and Anastomosis or Stricturoplasty, as these procedures directly address the obstruction and can be effective in relieving symptoms 2, 3. However, the choice between these options depends on the specific circumstances of the patient, including the presence of any complications and the patient's overall health status.