الجامعة السورية الخاصة كلية الطب البشري قسم الجراحة Small and Large bowels disease, Surgical management Dr M.A.Kubtan MD - FRCS 1

ANATOMY OF THE SMALL AND LARGE INTESTINES The small intestine : starts at the pylorus and extends to the ileocaecal valve. It is approximately 7 m in length. Is divided into the duodenum, jejunum and ileum. Its main function is in the breakdown and absorption of food products. It has very rich blood supply from superior mesenteric artery. The nerves are supplied from the coeliac plexus. 2

3 Large intestine : The large intestine extends from the ileum to the anus. The colon is approximately 1.5 m in length. The blood supply of the colon is derived from branches of the superior mesenteric vessels. The descending colon receives its blood supply from branches from the inferior mesenteric but also communicates with the superior mesenteric system via the marginal artery of Drummond.

Etiology of Intestinal disease Small bowel : Congenital : Seen in children. Acquired : Internal Hernias, Hernias of Abdominal wall. Adhesions : post operative complication. post inflammatory bowel disease ( Acute appendicitis, Cholecystitis, Michaels diverticulitis, Crohns disease ). Tumors : Primary, Secondary. Foreign bodies ( Worms, Phytobizaware, Tricobizaware, Ileal gall stone ). 4

5 Large bowels disease : Carcinoma 65% Volvulus 5% Colonic diverticulitis 20% Miscllenuous 10%

Types of Surgical procedures Laparoscopic surgical approach. Conventional surgical approach. Lyses of adhesions. Resection. Anastomsis. Colostomy. Surgical drainage. 6

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