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Small Bowel

Small Bowel Surgery

Small Bowel Resection
With End-to-End
Anastomosis Using the Gambee Technique

Small Bowel Bypass
With Ileoileal
Anastomosis and
Mucous Fistula

Small Bowel Bypass
With Ileotransverse
Colostomy and Mucous

Terminal Ileectomy
With Right Colectomy
and Ileotransverse

Terminal Ileectomy With Right
and Ileotransverse

The presence of a tumor or severe irradiation damage to the terminal ileum and right colon, with or without obstruction, may require resection of the affected area.

Physiologic Changes. Resection of a portion of the terminal ileum is associated with a loss of absorption of the fat-soluble vitamins A, D, C, and K. Vitamin B12 is normally absorbed in the terminal ileum; thus when the terminal ileum is absent B12 must be given systemically.

Loss of the terminal ileum creates changes in cholesterol metabolism and bowel salt reabsorption. If undigested fats are dumped directly into the transverse colon, the osmotic pressure of the colon is elevated, and diarrhea results.

Points of Caution.  After the abdomen has been opened through a midline incision extended to the xiphoid, care should be taken to identify the blood supply to the right colon and terminal ileum. If at all possible, the colon should be transected distal to the middle colic artery. The ileocolic artery frequently has to be clamped and tied.


The line of transection from the transverse colon to the ileum is shown. These transections are frequently made with the gastrointestinal anastomosis (GIA) stapler to minimize spill from the intestine. The ileocolic and the right colic artery should be identified, transected, and tied. The line of Toldt lateral to the right colon should be excised with scissors or cautery. The hepatocolic ligament should be incised with a cautery or clamped and tied.

The resected terminal ileum and right colon can be seen. Care should be taken to fully identify the right ureter prior to resection. A indicates aorta; IVC, inferior vena cava.

The GIA stapler connects a side-to-side anastomosis of the ileum and colon.

A TA-55 stapler has closed the defect in the bowel. A large anastomosis has been made between the terminal ileum and the transverse colon. The mesentery between these two pieces of bowel is closed with interrupted suture to prevent internal hernia.

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