Do I Need My Large Intestine? Do I Need My Small Intestine?

The gastrointestinal tract is a varied and complex bodily system. Two critical components of this system are the large and small intestines. While you may initially think that the large intestine is longer, that’s not the case. Actually, large and small refer to the diameter of the intestines. The small intestine is very long (20 feet!) and thin, while the large intestine is shorter and wide.

As with anything in the human body, the intestines are at risk of disease. These diseases may be congenital (at birth) or acquired. They may be caused by environmental influences or by genetics. Regardless of the cause, it is crucial that appropriate treatments are employed to minimize the disruption to the GI tract.

So, The First Question Is: Can I Live without My Large Intestine

The short answer is yes. The large intestine, known as the colon, processes and directs waste into the rectum where it is expelled during a bowel movement. The colon uses lots of water to formulate and ultimately push fecal matter out. But the large intestine can be subject to disease from any number of causes. Most commonly, we see patients with diverticulitis or cancerous or benign colon polyps found during a routine colonoscopy. The appendix is also part of the colon and some patients may require its removal, if it is inflamed.

The most common surgical procedure for diseases of colon is a colectomy – the removal of part or all of the colon. For most, a colectomy results in a relatively normal life. Some require a temporary colostomy (hole in the abdominal wall for the removal of fecal matter), while others may require a permanent colostomy – this all depends on how healthy the surrounding tissue is after a colectomy and whether we can attach both ends.

While it is certainly more difficult to attain normal GI function after the complete removal of the colon, most patients go on to live a healthy, full life.

But Can I Live Without My Small Intestine?

Here’s where it gets tricky. It is A LOT more difficult to live without your small intestine. Yes, there are procedures that bypass part of the intestine (gastric bypass and duodenal switch), there are even procedures that remove a part of the small intestine, known as a small bowel resection. However, very few patients will experience a disease widespread enough to warrant complete removal of the small intestine. The most common reasons for removing part of the small intestine include:

• Intestinal blockage form scar tissue or a tumor
• Damage from radiation therapy
• Cancer
• Congenital (birth) defects
• Short bowel syndrome (where half or more of the small intestine is missing or removed)
• Other trauma or damage

Much like surgery on the colon, the small bowels require healthy tissue on either end of the surgical resection to create an anastomosis (connection). If there is not enough healthy tissue a hole is made in the abdomen and the small intestine dumps it contents into an external drain bag. This is known as an ileostomy, which can be temporary or permanent.

If, in the rarest of cases, a patient required removal of almost all of their small bowel, they would cease to absorb many important nutrients and not enough water would be absorbed into the body. In this case, there are two options: a) to proceed with an intestinal transplant, replacing diseased small bowel with a healthy donor bowel or b) intravenous nutrition, which in about half of all cases can lead to liver disease.

In every case, we do all we can to spare healthy intestinal tissue. We always identify and begin with the most conservative and least invasive option that suits the patient best. We encourage you to contact our office to learn more about your surgical options as they relate to your GI tract and one of our four highly skilled surgeons will be happy to offer the breadth of treatment options and outcomes available to you.