OR / Prep · General Surgery · open
You’re scrubbing into
Small bowel resection & anastomosis
Why are we operating?
Segmental removal of non-viable or diseased small bowel with restoration of continuity.
Indication: Ischemic, obstructed non-viable, perforated, or tumour-bearing small bowel.
Read the imaging first
Practice before you scrub
Read the obstructed abdomen
Colicky central pain, distension, bilious vomiting, and an appendicectomy scar. Abdominal radiograph. (Fictional educational case.)
- Adhesional SBO earns a genuine trial of conservative management, with written exit criteria: deterioration, peritonism or a failed contrast transit means theatre.
- Strangulation rewrites the tempo: constant pain, tenderness and lactate turn tonight's plan from a drip into an operation.
The operation in 4 steps
01Assessing viability
Colour, peristalsis, mesenteric pulsation, and bleeding from cut edges judge which bowel lives.
02Resection
Mesentery scored and vessels ligated in a V toward the specimen; bowel divided between clamps.
03Anastomosis
The two ends are joined, hand-sewn in layers or stapled side-to-side.
04Closure
Mesenteric defect closed, counts completed, abdomen closed in layers.
Anatomy you need
Turn the bowel and note how mesentery carries the blood supply; a resection is planned on those arcades.
What can go wrong
Anastomotic leak
Day 3–7: tachycardia, fever, abdominal pain, ileus that fails to resolve, or subtle deterioration that 'doesn't add up'.
Postoperative ileus
Distension, absent flatus, intolerance of diet, and quiet bowel sounds in the days after abdominal surgery.
Postoperative bleeding
Tachycardia first, hypotension late; falling urine output; a distending abdomen or rising drain output.
Watch it done
Ileocolic bowel resection with primary anastomosis
A peer-reviewed protocol preview: mobilisation, division and a stapled anastomosis.
Source: JoVE, Journal of Visualized Experiments · Watch on YouTube
Conceptual teaching for learners preparing to observe and assist under supervision, not operative instructions. Five minutes from now you should know why this operation exists, what its shape is, and which structures it is designed not to injure.