• Joel Bauer MD
  • Stephen Gorfine MD
  • David Chessin MD
  • Daniel Popowich MD

Ileocolic Resection

Ileocolic Resection

Manhattan Abdominal Surgeons

There are some conditions, such as cancer and Crohn's disease that require removal of the last segment of small intestine (ileum) and the first segment of the large intestine (colon). This procedure is called an ileocolic resection.

Learn more about this procedure and how our Manhattan colorectal surgeons can help you. Call us at 646.798.4606 or send us an email today.

Diagnosis

Colon cancer and Crohn's disease are diagnosed using a combination of patient history, physical examination, endoscopy, radiology, and pathology. The diagnosis is often made using colonoscopy with biopsies. When patients have endoscopy or surgery for the disease, tissue is often submitted to the Pathologist for evaluation. The pathologist looks at the tissue under the microscope and helps make the diagnosis.

Radiology tests that may be ordered include:

  • A plain X-ray
  • A CT scan of the chest
  • Scans of the abdomen and pelvis

These studies are often utilized in the evaluation for evidence of metastatic disease (tumor spread beyond the primary site in the colon) in cancer and to evaluate potential complications of Crohn's disease (perforation, obstruction, or fistula).

Treatment

The treatment of colon cancer varies based upon whether there is spread beyond the primary site in the colon. If there is no spread beyond the primary site in the colon, the treatment is often removal of the involved colon. Following removal of the colon, the pathologist will evaluate the tumor under the microscope and give it a stage based upon the depth of penetration of tumor in the wall of the colon and the presence of tumor in the lymph nodes surrounding the tumor. Based upon the stage of the tumor, postoperative chemotherapy may be recommended. Chemotherapy is administered by a medical oncologist.

In selected patients with limited spread in the liver or lungs, removal of the involved colon along with the tumor in the liver or lungs may be feasible. The recommendation for this treatment strategy is individualized based upon the extent of disease and overall clinical presentation of the patient. If this approach is chosen, it is common for postoperative chemotherapy to be administered.

If there is tumor spread beyond the primary tumor and it is not amenable to removal, surgery may not be recommended. In this situation, chemotherapy is often administered.

Treatment for Crohn’s Disease

The treatment of Crohn's diseases varies between patients, based upon the location of the disease, the severity of symptoms, and the presence of complications such as obstruction, perforation, abscess, or fistula.

Often, the initial treatment in non-surgical and is commonly directed by a gastroenterologist. The medications used for Crohn's disease vary, but include:

  • Aminosalicylates
  • Antibiotics such as Cipro and Flagyl
  • Steroids
  • 6-MP/azathioprine
  • Methotrexate
  • Remicade
  • Humira

Indications for surgery include worsening symptoms despite adequate medical therapy, intolerance of medical therapy, complications of the disease (obstruction, perforation, abscess, or fistula), and difficulty maintaining nutrition. Depending on the location of the Crohn's disease, intestinal resection (removal) may be recommended. A common surgical procedure performed for Crohn's disease is an ileocolic resection.

Preparation

The night prior to the procedure, you will be instructed to take nothing to eat or drink after midnight. In addition, you will be prescribed a bowel preparation. The preparation should be taken as instructed.

Anesthesia

For an ileocolic resection, you will receive general anesthesia, in which you are completely asleep and monitored at all times by an anesthesiologist.

Operation

After anesthesia is established, an incision will be made in your abdomen and the abnormal ileum and colon will be identified using the laparoscope. This segment of ileum and colon will be removed, and the two ends reconnected (anastomosis). Rarely, a diverting stoma (bag) will be performed. Often a stoma is performed to maximize the safety of the operation for you. You will have a dressing placed over the operative site.

Postoperative Care

Following an ileocolic resection, you will be admitted to the hospital. You will receive pain medication and intravenous fluid. Once bowel function returns, as evidenced by passage of gas or stool, your diet will be advanced. Once you tolerate a diet, and have no signs of fever or other complications of the surgery, you will be discharged from the hospital. You will be given a prescription for pain medication. In the 1-2 weeks following surgery, you will see your surgeon for a follow-up appointment.

In the intervening time period, you should contact your surgeon with any questions or concerns.

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