Diseases of the Small Intestine
Dr. Konstantinidis MD, PhD, FACS - General Surgeon & Director of Bariatric, Laparoscopic & Robotic Surgery of Athens Medical Center.
There are many types of diseases that affect the small intestine. Certain conditions affect the way food is digested and absorbed by the body. Others are caused by inflammation, ulcers or infection.
Small bowel disease can lead to further complications if left untreated, so it is important to see a doctor if you are experiencing any related symptoms.
What is the small intestine?
The small intestine is the largest part of the digestive system with a length that exceeds six (6) meters in adults! It connects the stomach to the large intestine and folds several times to fit inside the abdomen.
The small intestine performs most of the digestion of the food we eat.
It consists of three (3) parts:
- the duodenum,
- the jejunum and
- the ileum
What are the most common Diseases of The Small Intestine?
The most common surgically treated diseases of the small intestine are:
- Crohn’s disease
- ileal adhesions
- Meckel’s diverticulum
- small bowel fistulas
- small bowel tumors
What is Crohn’s Disease?
Crohn’s disease is an idiopathic inflammatory bowel disease that can adversely affect a person’s health.
While medication is often the first treatment option, many people with Crohn’s disease eventually need surgery.
Read More here.
What are Ileal Adhesions?
Obstruction of the intestine or adhesive ileum is a very urgent condition that if left untreated can be life threatening and therefore requires immediate surgery.
Read More here.
What is Meckel’s Diverticulum?
Diverticula are abnormal sacs or follicles that develop at a weak point in the intestine. Meckel’s diverticulum is an embryological remnant of the umbilical cord.
It usually develops between the fifth and seventh week of fetal development. Because the condition is present at birth, it is classified as a congenital health problem.
The symptoms of the disease are related to the type of diverticulum for each patient. In 95% of people with this condition, the diverticulum that develops is made up of intestinal cells.
As a result, the diverticulum functions as a normal part of the gut. This type of diverticulum cannot cause significant symptoms.
In other cases, the diverticulum may be made up of stomach or pancreatic cells, thus leading to serious symptoms, such as:
- intestinal obstruction
- bleeding in the intestines
- inflammation in the intestines
- pain or discomfort ranging from mild to severe
- nausea and vomiting
What are Small Intestinal Fistulas?
The small intestine fistula is an abnormal channel of communication between two epithelial surfaces that usually includes the intestine on the one hand and another hollow organ on the other, such as the bladder, urethra, vagina or other areas of the gastrointestinal tract.
Fistulas may also form between the intestine and the skin or between the intestine and an abscess cavity.
Rarely, fistulas occur between a blood vessel and the intestine, resulting in deep bleeding of the gastrointestinal tract, which is a surgical emergency.
Most gastrointestinal fistulas (75% -85%) occur as complications of abdominal surgery. However, 15% -25% of fistulas occur spontaneously and are usually the result of intra-abdominal inflammation or infection.
What Are Small Bowel Tumors?
Small bowel tumors are rare. They are usually single, but may be multiple, especially in patients with certain syndromes, such as intestinal polyposis syndrome.
Small bowel tumors can be benign or malignant.
Some benign tumors can evolve and become malignant (i.e. adenomas, leiomyomas).
Most small bowel tumors are clinically silent for long periods of time. Almost half of all benign tumors of the small intestine are found only incidentally either during surgery or an examination of the bowel for other reasons.
Symptoms can be chronic and / or intermittent and include abdominal pain, nausea, weight loss and bleeding.
The larger the tumor, the more likely the patient is to show symptoms of bowel obstruction. Tumors can also cause ulcers and bleeding.
What are the symptoms of Small Intestine Diseases?
The signs and symptoms of small bowel disease vary. Patients usually feel discomfort around the abdomen, rectum and lower abdomen. Symptoms may include:
- swollen, painful abdomen
- rectal bleeding
- sudden weight loss
How is Small bowel Disease diagnosed?
The diagnosis of small bowel diseases includes a series of tests, such as:
- advanced imaging that includes computed tomography (CT) and magnetic resonance imaging (MRI)
- blood test
- special stool blood analysis, such as FIT and FOBT
- capsule endoscopy, a non-invasive method of imaging and examination of the small intestine
Make an appointment with the doctor!
How Are Small Intestine Diseases Treated?
The treatment of diseases generally focuses on two separate goals:
- causing the disease to subside and
- preventing relapse
Depending on the case, treatment can be conservative, with medication.
However, if the disease and the consequent damage to the small intestine is extensive and if patients do not respond to medication, then the treatment of small bowel disease is surgical.
The most common surgical procedure is enterectomy.
Enterectomy refers to the surgical removal of part of the intestine. It is performed under general anesthesia.
The procedure can be performed laparoscopically, with the help of a robotic system or with open surgery, as the case may be.
What is Laparoscopic Enterectomy?
During the laparoscopic enterectomy the surgeon makes about 3-4 small incisions in the patient’s abdomen.
A tube is inserted through the incision and carbon dioxide gas is pumped through to inflate the patient’s abdomen. This procedure allows the surgeon to see more easily inside the abdomen.
The laparoscope is inserted through another hole, an instrument with a micro-camera attached at its end, allowing the surgeon to see inside the abdomen.
The surgical instruments are inserted in the other small openings and used to remove the diseased part of the small intestine.
The small intestine sample is then placed in a plastic bag and removed through one of the small incisions.
The intestine is reconnected (anastomosed) with special surgical staples.
Once this process is completed, carbon dioxide is released out of the abdomen through the same holes, which are then closed with sutures.
As a minimally invasive method, laparoscopic enterectomy is characterized by important benefits for patients, such as minimizing hospitalization time, blood loss during surgery, postoperative pain, risk of complications and recovery time and return to daily activities.
What is Robotic Enterectomy?
Robotic enterectomy is an evolution of laparoscopic enterectomy and is performed with the assistance of a robotic system consisting of an advanced surgical robot (da Vinci Xi) and a console, on which the surgeon sits.
Navigating the robotic arms from the console, the surgeon makes small incision, however, the surgical field is now fixed and three-dimensional and the surgeon has a huge degree of freedom and flexibility of movement.
Robotic surgical instruments are smaller and allow easier access to anatomical areas that are difficult to access with conventional means.
In addition, with robotic enterectomy, intra-abdominal anastomoses (reconnection of the intestine after removal of the affected part) are performed with greater comfort and safety than in laparoscopy.
What are the advantages of Robotic Enterectomy?
Robotic enterectomy incorporates all the advantages of the laparoscopic procedure offering additional capabilities to the surgeon.
The surgeon sits on a special console, without getting tired, allowing him to navigate the special, robotic arms that perform the operation.
The arms have incomparable precision, flexibility and stability in their movements, while at the same time they can access even the most inaccessible parts of the abdomen.
Also, the three-dimensional display of the surgical field and its large magnification with high resolution allows the surgeon to feel as if he is inside the patient’s body!
Thus, the risk of injury to healthy tissues and organs during the operation is minimized, contributing to the faster healing and recovery of the patient.
Due to its ease of movement and 3D imaging, the da Vinci Xi HD robotic system is really useful and effective in certain phases of enterectomy (bowel mobilization, vascular control, intra-abdominal suturing of anastomoses and recognition of nerves).
Make an appointment with the doctor!
Why Dr. Konstantinidis?
Dr. Konstantinidis and his Surgical Team have vast experience in dealing with all benign and malignant diseases of the small intestine.
Dr. Konstantinidis collaborates with doctors of all related specialties, such as Anesthesiologists and Gastroenterologists, who are all pioneering scientists and are distinguished for their medical work.