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Elisabeth Fandrich
A resection of the small bowel is a surgical procedure in which a section of the intestine is
removed. Common reasons that necessitate this surgery are Crohn’s disease, ulcers, cancer,
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intestinal obstruction, injury, and precancerous polyps. Patient 3501, C, T was brought to the
emergency room on March 30, 2008 by her family complaining of severe abdominal pain,
constipation lasting more than five days and a large bulge of the left groin. It was determined that
the patient had developed a left inguinal hernia with possible bowel obstruction. Surgery was
indicated. As with any type of surgery, a signed consent form is required. The procedure, what
can be expected, risks, and goals are discussed with the patient. The patient must take no food or
fluids after midnight the night before the surgery. Blood and urine labs will be collected as well as
tube and foley catheter. After 3501,C,T was admitted to the emergency department, routine
hematology and chemistry labs were drawn. When it was determined that she would require
surgery, labs were drawn for coagulation and blood bank tests. The initial blood work showed an
elevated WBC of 18.70 indicating acute infection, elevated platelet count of 448 (normal 140-
400), elevated % neuts, absolute neuts and % lymphs. Sodium, potassium, chloride, and total
CO2, were low indicating dehydration and electrolyte imbalance. Serum glucose was slightly
elevated at 127 (normal range 65-110) may be attributed to the stressful situation, but will most
likely be monitored to rule out diabetes mellitus. BUN was elevated at 40 (normal range 7-23)
due to dehydration. Calcium was slightly elevated at 10.8 which may be related to the patient’s
history of osteoperosis. Serum protein was slightly elevated at 8.2 (normal range 6.2-8.1) which
may be attributed to dehydration. A/G ratio was slightly low perhaps because of vitamin C
supplementation or malnutrition. The ALT was also low at 18 (normal level 20-55) which might
be attributed to stress.
The small bowel resection is routinely done by placing the patient under general anesthesia,
making a midline incision, removing the diseased or damaged bowel then suturing or stapling the
remaining sections together. Upon entering 3501,C,T’s abdominal cavity, the surgeon found a
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large amount of dilated bowel. The surgeon followed this down to the hernia and found that a
section of the bowel and some of the omentum was reduced and strangulated. The surgeon
determined that the creation of a stoma was not necessary. The incision is then closed. The
removed sections of 3501,C,T’s intestine and omentum were sent for pathologic diagnosis. The
final pathologic diagnosis showed that there was an area of ulceration of the mucosa. The wall of
this area was very thing and had focal necrosis of the mucosa. The findings were consistent with
ischemic necrosis. The patient developed a hernia into which an area of intestine slipped and
became strangulated causing necrosis of the tissue and obstruction of the bowel.
The surgery performed on 3501,C,T was completed without complication and she was admitted to
the surgical floor after being monitored in the post anesthesia care unit. Mild pain at the incision
site is expected after a bowel resection surgery. This pain was experienced by 3501,C,T and
treated with patient controlled analgesia (PCA) effectively. The patient was instructed on the use
of splinting when coughing and deep breathing and the importance of incentive spirometry. The
patient has a history of COPD so O2 at a flow rate of 3-4L was administered. The nasogastric
tube and foley catheter were left in place. The NPO status was maintained but the patient was
allowed to relieve dry mouth with ice chips. The surgeon ordered TED hose and sequential
compression devices to help prevent the formation of DVT. Bed rest is normally enforced for the
The length of time required for recovery from a small bowel resection surgery depends on many
variables (i.e. overall pre-operative heath status, age, amount of intestine removed, the condition
which led to the need for bowel resection). 3501,C,T is an 81 year old female with a history of
COPD and osteoporosis. The patient lives independently and has an extensive social and family
support system. No complications are anticipated for this patient’s recovery, but some potential
complications are infection, injury related to falling, impaired skin integrity, ineffective pain
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drug allergies.
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References
Small Bowel Resection. (2007). Small Bowel Resection. In Encyclopedia of Surgery: A Guide
for Patients and Caregivers [Web]. Advameg Inc.. Retrieved March 31, 2008, from
http://www.surgeryencyclopedia.com/Pa-St/Small-Bowel-Resection.html
Lee, MD, J.A. (2006). Small Bowel Resection. In Medline Plus [Web]. Bethesda: A.D.A.M.