Injuries to the abdomen and intestinal pathology can cause the need for surgery - resection of the sigmoid colon. The operation can be both planned and emergency. If we consider the medical statistics, then in 80% of cases such surgery is carried out urgently. Immediately before the operation, the patient must undergo the necessary training. These activities are aimed at eliminating the complications and negative consequences of radical therapy.
The location of the sigmoid colon
The name of the body given in connection with the fact that in its form it has similarities with 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 accurately and accurately as possible.
In turn, the location of the sigmoid colon facilitates the process of diagnosis. The specialist can identify some pathologies during the examination of the patient and palpation. This diagnostic method allows an experienced physician to determine the peristalsis of a given intestinal section, its thickness, texture and surface density. At the same time, taking into account the patient's sensations during palpation are taken into account - pain and discomfort confirm the hypothesis of the 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 tumors, then additional diagnostic methods will be assigned. Also, the reason for a more thorough investigation 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 most cases, radiography or sigmoidoscopy is prescribed. Laboratory examinations of feces, blood and urine are mandatory. Female patients are additionally sent for gynecological examination in order to exclude pathologies of the reproductive system, which symptoms are similar to the inflammatory diseases of the sigmoid colon.
Indications for resection
Resection of the sigmoid colon is the removal of a part or the whole part of the intestine, constituting an eighth of its total length. Therefore, surgery 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 the patient's pain and ill-being is sigmoiditis (inflammation of the organ), then antibiotics and a therapeutic diet are prescribed for him. Additionally, drugs can be prescribed to eliminate the symptoms of the disease - painkillers, antipyretic.
The resection is appointed at more serious pathologies:
- the presence of tumors in the lumen or on the walls of the intestine;
- diverticulitis is a pathology with the development of which saccular protrusions appear on the intestinal walls;
- inversion of the intestinal section;
- intestinal obstruction;
- polyps and growths of a malignant nature, which are characterized by frequent constipation and pain.
Preparation for surgery
Approximately one day before resection of the sigmoid colon, the patient begins to prepare for the procedure. First of all, it is necessary to completely clean the intestines, this is the key to reducing the risk of postoperative complications. Special laxative preparations or enemas can be used for cleaning, the choice depends on the patient’s individual indicators. If the operation is planned, then a week before it is performed a special diet is shown to the patient, which includes only liquid meals and dairy products.
Additionally requires the use of drugs that contribute to the stabilization of 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 the operation - they affect the function of platelets, which entails a change in the characteristics of blood clotting.
In the case of patients receiving vitamins and dietary supplements, it is recommended to abandon them for a certain period of time.
It is just that some active substances can thin the blood or affect the cardiovascular system, and this can cause complications in the course of a sigmoid resection surgery.
Course of operation
There are several techniques for performing sigmoid resection, the choice depends on the nature and cause of the pathology. For example, a patient who has a twisted bowel due to a congenital anomaly, is shown an urgent operation on Mikulich or Hartmann. In the first case, the dead part of the intestine is excised, then parts of the sigma are stitched 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 eliminated, and the intestine gets the pre-operative form, only becomes somewhat shorter.
According to the method of Hartmann after the removal of the atrophied part of the intestine, the passage opening is brought out. Such an intervention implies a much smaller burden on the body, but it will be impossible to return to the usual way of life after it. Therefore, when the patient is stronger, an intestinal formation surgery may be indicated.
In tumors and polyps in the middle third of the sigma, the entire organ is removed. First, the surgeon through the incision of the abdominal wall removes the bowel loops, imposes the anastomosis and excised the affected part of the intestine. If pathology allows you to "get along" by removing half of the sigma, then after excision, the remaining parts are stitched together, which allows you to restore the natural functions of the intestine.
It should be understood that the removal of part of the intestine affects the function 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 must be easily digestible.
In the first 10 days after surgery, a particularly strict diet is shown, then boiled fish and chicken are gradually added to the diet. Adding new products is very similar to the first baby food - it takes a couple of days to check the body's reaction to them. On average, the adaptation of the intestine to the "new conditions" requires 1.5-2 months.