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Bacterial overgrowth The small intestine can become colonised with bacteria normally confined to the colon if there is stasis resulting in delayed bacterial clearance (blind loop syndrome; 74.9 ). Similar complications may result from chronic small bowel obstr...

Benign The majority of small bowel neoplasms are benign, comprising adenomas, lipomas, haemangiomas and neurogenic tumours. They are frequently asymptomatic and identified incidentally , James Israel , 1848–1926, first found sulphur granules in pus from a disch...

CONDITIONS CAUSING MALABSORPTION Coeliac disease Coeliac disease is the most common cause of malabsorption in the UK with a reported prevalence of 1:1800, although this may be an underestimate. It is characterised by a hyper- trophic small bowel mucosa with ...

CONNECTIVE TISSUE DISORDERS Intestinal diverticula Diverticula (hollow outpouchings) are a common structural abnormality that can occur from the oesophagus to the recto sigmoid junction. Small bowel diverticula may be congenital or acquired. In congenital dive...

Chronic small intestinal ischaemia Chronic small intestinal ischaemia almost invariably results from atherosclerosis and a ff ects the proximal superior mesen teric and coeliac vessels. Patients classically present with symptoms of severe central abdominal pai...

Complications of stomas Stoma complications are underestimated and common ( Summary box 74.6 ). On occasion, these complications require surgical revision. Sometimes, this can be achieved with an incision immediately around the stoma, but on occasion reopening...

ENTEROCUTANEOUS FISTULA An abnormal connection between the small intestine and the skin can occur as a result of CD, radiotherapy or abdominal trauma, but the condition most commonly follows a surgical - complication – either a leak from an anastomosis or an ...

End-ileostomy An end-ileostomy is formed after a colectomy without anas - tomosis, when it may later be reversed, or after panproctocol - ectomy , when it is permanent. The ileum is normally brought through the rectus abdominis muscle. Careful attention should...

Human immunodeficiency virus Human immunodeficiency virus (HIV) infection is associated with a number of proctological problems (see Chapter 80 Intestinal complications are common after the development of acquired immunodeficiency syndrome (AIDS), when opportun...

I N F E C T I V E E N T E R I T I S Campylobacter Infection with Campylobacter jejuni (a Gram-negative rod with a distinctive spiral shape) is the most common form of bacte - rial gastroenteritis in the UK, typically acquired from eating infected poultry . I...

INFLAMMATORY BOWEL DISEASE The term ‘inflammatory bowel disease’ is reserved for conditions characterised by the presence of idiopathic intes tinal inflammation; conditions such as infective or ischaemic enteritis are, by definition, excluded. Crohn’s disease (CD...

Introduction No content extracted automatically.

Learning objectives To appreciate: The basic anatomy and physiology of the small intestine intestinal problems • The range of conditions that may affect the small intestine • To understand: The aetiology and pathology of common small intestinal multidisciplina...

Loop ileostomy A loop ileostomy is often used for defunctioning a low rectal anastomosis or an ileal pouch. A knuckle of ileum is exterior - ised through a skin trephine in the right iliac fossa. An incision is made in the distal part of the knuckle, and thi...

PHYSIOLOGY OF THE SMALL INTESTINE The principal function of the small intestine is the digestion of food and absorption of nutrients, water and electrolytes. Carbohydrates and proteins are broken down in the intestinal lumen by pancreatic enzymes, but the fi...

SHORT BOWEL SYNDROME/ INTESTINAL FAILURE Intractable diarrhoea with impaired absorption of nutrients following resection or bypass of the small intestine, ultimately leading to progressive malnutrition, is referred to as short bowel syndrome. When a patient i...

STOMAS A stoma is an artificial opening made in the bowel to divert faeces and flatus outside the abdomen, where they can be collected in an external appliance. Depending on the purpose Bryan Nicholas Brooke , 1915–1998, Professor of Surgery , St George’s Hospi...

Stoma bags and appliances Stoma output is collected in a disposable adhesive bag. Ileostomy appliances tend to be drainable bags that are left in place for 48 hours, while colostomy appliances are simply changed two or three times each day . A wide range of s...