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Robert Sewell, MD, FACS

Minimally Invasive Surgeon - Southlake, Texas

About the Small Intestine


The small intestine, also called the small bowel, is a tubular organ, approximately 18 feet long, which winds back and forth within the abdominal cavity. It is composed of three parts, the duodenum, the jejunum and the ileum. The duodenum begins at the end of the stomach, and the ileum ends where it empties into the colon. The small intestine is where virtually all nutrients, including proteins, carbohydrates, fats, vitamins and minerals are absorbed into the body.  The lining of the intestine is composed of billions of tiny fingerlike projections, called villae, that dramatically increase the total surface area available for nutrient absorption. The muscles of the intestine contract in a rhythmic manner, keeping the food being digested moving steadily down the tube, a process known as peristalsis.


Symptoms of Intestinal Obstruction


The most common surgical problem involving the small bowel is intestinal obstruction.  If the intestinal tube becomes blocked for any reason, peristalsis will continue to try and push the contents forward. As the pressure builds inside the bowel the patient will experience:


  • nausea

  • vomiting

  • cramping abdominal pain


Within a few hours the intestine above the area of obstruction will become distended with gas and fluid, resulting in a gradual bloating of the entire abdomen.


Testing for Intestinal Obstruction


The diagnosis of intestinal obstruction is usually made by a combination of physical findings of a distended abdomen with very active bowel sounds. An x-ray of the abdomen will generally show dilated loops of bowel. If the intestine is completely blocked, surgery is usually the only way to resolve this life threatening condition. The most common causes of intestinal obstruction are adhesions from prior surgery, hernias with trapped intestine, and cancer. The actual cause of the obstruction can be difficult to determine until the time of surgery.


Minimally Invasive Treatment Options


A Laparoscope can usually be introduced into the abdomen to determine the cause of the intestinal obstruction, and occasionally it is possible to actually resolve the blockage with this technique. However, it can be difficult to deal with adhesions involving most of the 18 feet of intestine, so conversion from laparoscopy to open incision surgery is not uncommon.