What is the ileum?
In conditions where the ileum is removed surgically, the duodenum is connected to the colon. This is called anastomosis.
The entire small intestine is around 20 feet long and is divided into three parts.
- The first part is called the duodenum. The stomach opens into the duodenum.
- The middle part is called the jejunum.
- The third and final part is called the ileum.
The ileum opens into the large intestine controlled by the Ileocecal valve.
The ileum is responsible for the digestion and absorption of nutrients like vitamin B12, fats, bile, and everything else not digested in the rest of the intestine. The undigested food enters the large intestine to get excreted.
The Ileocecal valve is a muscle at the junction of the ileum and the first part of the large intestine or colon. Its main function is to regulate the passage of undigested food from the small intestine to the large intestine.
Why is ileal removal done?
Surgical removal of the ileum is also called small bowel resection. The most common reasons for the surgery may be:
- Uncontrolled bleeding due to perforated ulcers or injury.
- Blockage of the ileum due to tumors or scar tissue.
- Birth defects like Meckel’s diverticulum (outpouching of the small intestine).
- Infections and ulcers that do not respond to medication.
- Inflammatory conditions like Crohn's disease.
Why is the ileocecal valve removed?
Ileocecal valve is removed in case of:
- Crohn's disease complicated by stricture (narrowing) of the valve.
- Tumors in the area of the ileocecal valve.
- Trauma, infection, or bleeding in the area of the valve.
What happens when the ileum is removed?
In conditions where the ileum is removed surgically, the duodenum is connected to the colon. This is called anastomosis. The ileum is removed surgically under anesthesia. Patients may typically stay in the hospital for around a week after surgery. It could take 6 to 8 weeks to completely recover.
Though this surgery may be necessary and even lifesaving, the ileum is responsible for the digestion and absorption of nutrients like vitamin B12, fats, bile, and everything else that is not digested by the rest of the intestine. Removal of the valve can cause difficulty in absorbing nutrition and other digestive problems like diarrhea.
However, it is possible to survive without the ileum with appropriate postoperative care, nutritional therapy, and digestive aids.
Like any surgery, ileal resection also has risks of complications. Some possible complications of surgery are:
- Swelling, bruising and pain which usually resolves in around 2 weeks
- Infection
- Bleeding
- Damage to surrounding structures
- Reaction to anesthesia
- Localized blood clot (hematoma) and smaller blood clots which may travel through blood vessels, causing heart and lung complications
- Wound dehiscence (a condition where the cut made during a surgical procedure separates or ruptures after being stitched together)
- Seroma (fluid collection)
- Anastomotic leak (intestinal contents may leak through the site of anastomosis) which may lead to systemic infection
- Anastomotic stricture
- Scarring and adhesions leading to bowel obstruction
What happens if the ileocecal valve is removed?
When the ileocecal valve is removed, like any surgery, there is a risk of complications during and after surgery. The valve functions to move undigested food from the ileum to the colon, to prevent the backflow of digested contents from the large intestine and block colon bacteria from spreading back into the small intestine.
Some possible complications of ileocecal valve removal are:
- Excessive bleeding
- Infection
- Localized blood clot and smaller blood clots which travel through blood vessels to cause heart and lung complications
- Wound dehiscence (a condition where the cut made during a surgical procedure separates or ruptures after being stitched together)
- Anastomotic leak (intestinal contents may leak through the site of anastomosis) which may lead to body-wide infection.
- Anastomotic stricture (constriction at the site anastomosis)
- Scarring and adhesions leading to bowel obstruction