Expert Opinion: Diverticulosis

Procedures for Extreme Cases

Q: In extreme cases of inflammatory bowel diseases, or IBDs, such as Crohn's disease, sometimes part of the colon needs to be removed. Can you discuss these types of procedures, and then how people go on living their lives once part of the colon has been removed?

A: The gastrointestinal tract is very long, and there is a lot of reserve capacity. Some people have disease in part of the gut or intestinal tract, and sometimes part of the tract has to be removed by a surgeon. Now, the removal of part of the intestinal tract does not necessarily result in severe problems. Let's go over some parts that are commonly resected.

People who have cancer of the stomach will have their stomach - or part of it - taken out. Usually when this happens, it is important to pay attention to their nutritional state and to their diet. A lot of people who have this resection lose weight because they tend to eat less. That's due to the absence of the reservoir of the stomach. Therefore, people who've had part of their stomach removed should consult with a dietitian in order to choose the right foods and the right pattern of eating.

In this kind of situation, we suggest people eat small meals and eat frequently, because they don't have the reservoir to eat a large meal. It is also important to consult a dietitian, because people who have a complete resection of the stomach cannot absorb vitamin B12 and may need to receive B12 injections on a regular basis.

Now, if we move on to resections of the small intestines - as happens in people with Crohn's disease - the small intestine is very long, about 15 feet. You can remove large parts of the small intestine, and people can still have enough surface to absorb the food they need. Again, it is important in cases of resection of the small intestine that patients confer with a dietitian to get advice on proper foods and to guard against deficiencies that can arise because of these resections.

For instance, resection of the very end of the small intestine - the part called the terminal illium - may result in diarrhea. It may also result in lack of absorption of vitamin B12. By consulting with a dietitian or with a physician who has knowledge in nutrition, a lot of the problems that can arise from this [type of] resection can be addressed.

People who have severe Crohn's disease or another inflammatory bowel disease called ulcerative colitis, in which there is also a lot of inflammation and ulceration in the colon, may undergo a resection of the colon. One can live perfectly well without a colon. Initially there is a lot of diarrhea, but as time goes by the diarrhea can subside.

In centers where colon-resection surgery is frequently performed, the level of technical sophistication is very high. Surgeons can attach the small intestines to the area of the very end of the rectum, the anal area, and preserve the sphincter, giving people control over their bowel movements and eliminating the need to have a bag, which is a frightening concept for many people. In certain cases a bag is unavoidable, but these are a very small minority.