Perioperative management - Segmental jejunal resection with side-to-side anastomosis

• Tumor stenosis of the small intestine or extended stenotic strictures.
• In severe iatrogenic injuries of the small intestine which cannot be oversewn, thus requiring bowel resection.
• Urinary diversion draining the urine via a segment of the ileum excluded from the intestinal passage.
• In status post resection for ischemic small intestine.
• Resections of small intestine invaded by a primary in a different location.

• Even in segmental resections of the small intestine, the anastomosis may be a critical factor in healing: For instance, in a severely impaired blood supply or when the comorbidity of the patient is extreme, e.g., in septic shock.
• In such cases, a stoma should be considered and might be more prudent in certain situations, in order not to risk anastomotic failure!

• Cross-sectional imaging by CT or MRI is indicated in tumors.
• In chronic inflammatory bowel disease, MR enteroclysis (Sellink) imaging is the gold standard today.
• In exceptional cases, simple contrast imaging may be performed with a water-soluble contrast agent (a rather inaccurate study, in ileus cases the contrast agent fades away upstream of the stenosis without resulting in a meaningful image).
• Some cases may call for double-balloon endoscopy or capsule endoscopy, particularly when working up endoluminal findings.

• No special preoperative management is required:
• As a rule, it suffices to have the patient fasting during the night, as the small intestine empties rather quickly.
• Flushing with saline or other laxatives is common but, according to the latest data, lacks any positive evidence!

• General risks of surgery

In addition:

1. Risk of anastomotic failure.
2. When considering extensive small intestinal resections – especially in the terminal ileum – the patient should be informed that this may require substitution of vitamin B12, fat-soluble vitamins and calcium for life!
3. In planned extensive resections, inform the patient about the risk of short bowel syndrome!