What is Ileocecal Resection

Ileocecal resection, or ileocecectomy, is a surgical procedure to remove part of the small intestine. This procedure involves the end of the small intestine (terminal ileum) and the area where it connects to the large intestine (cecum).

You may need this procedure if you have bleeding, a hole (perforation), or an abnormal growth (tumor)in the terminal ileum or the cecum. This procedure may also be needed if there is damage to the ileum or cecum from a condition called inflammatory bowel disease, which can be caused by diseases such as Crohn disease. In most cases, after the damaged part of the intestine is removed, the two cut ends will be sewn together (anastomosis).

This procedure may be done in one of two ways:

• Open surgery. A single surgical cut (incision) is made in the abdomen.
• Laparoscopic surgery. The surgery is done through small incisions in the abdomen. A thin, lighted tube with a tiny camera on the end (laparoscope) is inserted into one of the incisions. Surgical instruments are inserted through the other incisions.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with the use of anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Bleeding.
• Infection.
• Allergic reactions to medicines or dyes.
• Leaking of the anastomosis.
• Damage to other structures or organs in your abdomen.
• A blood clot that may form in your leg (deep vein thrombosis).
• A blood clot that may form and travel to your lung (pulmonary embolism).

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.

General instructions

• Talk with your health care provider about the risks and benefits of this procedure.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• You may need to follow a special diet and take medicines to clean out your digestive system (bowel prep). You may need to start your bowel prep 2–3 days before the procedure.
• Plan to have someone take you home from the hospital or clinic.
• Ask your health care provider how your surgical site will be marked or identified.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical site.
• An IV tube will be inserted into one of your veins. You will receive medicine through this tube.
• You will be given the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• Once you are asleep:
  • A tube may be placed through your mouth to help you breathe.
  • A tube may be placed through your nose and into your stomach to drain stomach fluids (nasogastric tube, or NG tube).
  • A tube may be placed into your bladder (catheter) to drain your urine.
• Depending on the type of procedure that you are having, one incision or several small incisions will be made in your abdomen.
• Your surgeon will identify the area of the ileum and cecum that will be removed. This area will be separated from the surrounding structures.
• Blood vessels that will need to be cut will be tied with stitches (sutures) to prevent bleeding.
• After removing the terminal ileum and the cecum, your surgeon will sew together the cut edges with surgical staples, creating an anastomosis between the two areas.
• The anastomosis will be checked for leaking or bleeding.
• The inside of your abdomen will be washed out with germ-free salt-water.
• The incision(s) in your skin will be closed with sutures or staples.
• A bandage (dressing) will be placed over the incision(s).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may feel some discomfort. Your health care provider will give you medicine to help with any pain.
• Someone will help you change your bandage and use the bathroom.
• You will be encouraged to walk after you can get out of bed. This helps to prevent blood clots.
• You will have an IV tube for fluids and nutrition until you can start eating and drinking on your own.
• You may get medicines to prevent infections or blood clots.

Care After Ileocecal Resection

Here is the information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain.
• Bloating or nausea.
• Tiredness (fatigue).

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• If you were prescribed an antibiotic medicine, use it as told by your health care provider. Do not stop using the antibiotic even if you start to feel better.
• If you were prescribed pain medicine, do not drink alcohol while taking the medicine.

Incision care

• Follow instructions from your health care provider about how to take care of your incision area. Keep your incision area clean and dry. Make sure you:
  • Wash your hands with soap and water before and after applying medicine to the area or changing your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider says it is okay to do so.
• It is okay to take sponge baths until you have your stitches or staples taken out.
• You can take a shower a few days after staples or sutures have been removed, or as directed.

Activity

• Do not lift anything that is heavier than a gallon of milk, or the limit that your health care provider tells you, for the first 6 weeks after surgery.
• Take short walks often. Try to go for a 10-minute walk, 2 times a day.
• Do not participate in strenuous activities like running or aerobics for at least 6 weeks or as directed.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

Preventing constipation

• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.

General instructions

• Follow instructions from your health care provider about what to eat in the first few days after surgery. You may need to introduce foods slowly by starting with a soft diet.
• Continue to practice deep breathing and coughing. If it hurts to cough, try holding a pillow against your abdomen as you cough.
• Return to your health care provider as directed to have your stitches or staples taken out.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have a fever or chills.
• Your pain medicine is not helping.
• You have constipation, bloating, diarrhea, or nausea.

Get help right away if:

• You have chest pain or trouble breathing.
• You have severe pain that is not helped with pain medicine.
• You have heavy bleeding from your rectum, or you have black, tarry stools.
• You have not had a bowel movement for 4 or more days.
• You notice redness, swelling, or discharge around your incision.
• Your incision comes open.
• You have warmth, swelling, or pain in your leg.