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Injuries to the abdomen and intestinal pathology may cause the need for surgery – resection of the sigmoid colon. The operation can be both planned and emergency. If we consider medical statistics, then in 80% of cases such surgical intervention is carried out urgently. Immediately before the operation itself, the patient must undergo the necessary preparation. These measures are aimed at eliminating complications and negative consequences of radical therapy.
Location of the sigmoid colon
The name of the organ is given due to the fact that in its form it resembles the English letter “S”. The length of the sigmoid intestine is about 55 cm. It is located in the lowest part of the abdominal cavity, in close proximity to the uterus in women or the bladder in men. Therefore, during the operation there is a risk of accidental damage to neighboring organs. To avoid this phenomenon, the surgeon must work as carefully and as accurately as possible.
In turn, the location of the sigmoid colon somewhat facilitates the diagnostic process. The specialist can identify some pathologies when examining the patient and palpation. This diagnostic method allows an experienced doctor to determine the peristalsis of a given section of the intestine, its thickness, texture and surface density. At the same time, the patient’s sensations during palpation are taken into account – pain and discomfort confirm the assumption of pathologies of the sigmoid colon.
In the absence of deviations, the thickness of the intestine is about 2,5 cm, the density is average or above average, without increased peristalsis. If during the examination the doctor reveals seals or the presence of neoplasms, then additional diagnostic methods will be prescribed. Also, the reason for a more thorough study is the patient’s complaints of pain even with slight pressure in the left iliac fossa.
For a detailed diagnosis of the sigmoid intestine, in the vast majority of cases, radiography or sigmoidoscopy is prescribed. Laboratory studies of feces, blood and urine are mandatory. Female patients are additionally sent for a gynecological examination in order to exclude pathologies of the organs of the reproductive system, which are similar in symptoms to inflammatory diseases of the sigmoid colon.
Indications for resection
Resection of the sigmoid colon is the removal of part or the whole section of the intestine, which is an eighth of its total length. Therefore, the operation is prescribed only in the case when drug therapy does not allow to achieve recovery. If, as a result of the examination, it was revealed that the cause of pain and poor health of the patient is sigmoiditis (inflammation of the organ), then antibiotics and a therapeutic diet are prescribed to him. Additionally, drugs can be prescribed to eliminate the symptoms of the disease – painkillers, antipyretics.
Resection is prescribed for more serious pathologies:
- the presence of neoplasms in the lumen or on the walls of the intestine;
- diverticulitis – a pathology, during the development of which saccular protrusions appear on the walls of the intestine;
- volvulus of this section of the intestine;
- intestinal obstruction;
- polyps and growths of a malignant nature, which are characterized by frequent constipation and pain.
Preparing for an operation
Approximately one day before the resection of the sigmoid colon, the patient begins to prepare for the procedure. First of all, it is necessary to completely cleanse the intestines, this is the key to reducing the risk of postoperative complications. For cleaning, special laxatives or enemas can be used, the choice depends on the individual parameters of the patient. If the operation is planned, then a week before it is performed, the patient is shown a special diet, which includes exclusively liquid meals and dairy products.
Additionally, it is required to take drugs that help stabilize the general condition. These include diuretics, inhibitors, drugs that affect blood pressure, and the like. But anti-inflammatory drugs should be canceled 10-14 days before surgery – they affect the function of platelets, which entails a change in the characteristics of blood clotting.
If the patient is taking vitamins and dietary supplements, it is recommended to abandon them for a certain period of time.
Just some active substances can thin the blood or affect the cardiovascular system, and this can cause complications during the operation for resection of the sigmoid colon.
Course of operation
There are several methods for performing resection of the sigmoid colon, the choice directly depends on the nature and cause of the pathology. For example, a patient who, due to a congenital anomaly, had a volvulus of the intestines, is shown an urgent operation according to Mikulich or Hartmann. In the first case, the dead part of the intestine is excised, then the parts of the sigma are sutured in a special way and temporarily fixed on the abdominal wall. After 3-4 months, when the patient has recovered, a second operation is performed, during which the fistula is removed, and the intestines receive a preoperative form, only it becomes somewhat shorter.
According to the Hartmann method, after removal of the atrophied section of the intestine, the through hole is brought out. Such an intervention implies a much lower load on the body, but it will be impossible to return to the usual way of life after it. Therefore, when the patient gets stronger, an operation to form the intestines can be prescribed.
With neoplasms and polyps in the middle third of the sigma, the entire organ is removed. First, the surgeon removes the loops of the intestine through the incision of the abdominal wall, imposes an anastomosis and excised the affected area of the intestine. If the pathology allows you to “get by” with the removal of half of the sigma, then after excision the remaining parts are sewn together, which allows you to restore the natural functions of the intestine.
Rehabilitation period
It should be understood that the removal of part of the intestine affects the functions of the gastrointestinal tract as a whole. Therefore, during the recovery period, it is important to comply with all medical prescriptions regarding nutrition. Initially, only liquid dishes will be present in the diet, then mashed potatoes, cereals, and solid foods are gradually added. All food should be easily digestible.
In the first 10 days after the operation, a particularly strict diet is indicated, then boiled fish and chicken are gradually added to the diet. Adding new foods is very similar to a baby’s first solid food – it takes a couple of days to test the body’s reaction to them. On average, it takes 1,5-2 months to adapt the intestines to the “new conditions”.