The large intestine extends from the terminal ileum to the anus. It is five feet long and begins with the cecum, followed sequentially by the ascending colon, transverse colon, descending colon, sigmoid colon and anus. The large intestine absorbs water, minerals, and vitamins from intestinal contents. Undigested material is eliminated in the stool. A surgical resection involves removal of a part or all of an organ or structure and reattachment of whatever portion is not diseased, obstructed, perforated, or gangrenous.

The causes may be related to benign or malignant conditions. Benign conditions that may indicate the need for a resection because they could cause obstruction, perforation, gangrene or disease include: diverticulitis; ulcerative colitis; polyps; lipomas; adenomas; leiomyomas; volvulus; intussusception; and adhesions. For additional information related to etiologic factors listed above, see the following: Diagnostic Code: 7327 Diverticulitis, and Diagnostic Code: 7323 Colitis, ulcerative.

Malignant conditions that may indicate a need for resection because they could cause obstruction, perforation, gangrene or disease in the large intestine include: various types of cancer such as adenocarcinoma, lymphoma, melanoma, and sarcoma.

Manifestations for this code will depend upon the extent of the surgery. Patients who have undergone a simple bowel resection (hemicolectomy) for benign disorders will regain normal bowel function after a period of recovery. Those patients who have undergone a total colectomy for cancer or a massive resection such as proctocolectomy for ulcerative colitis will have a colostomy or ileostomy. Signs and symptoms that would continue after these extensive surgeries may include weight loss, dehydration, anemia, diarrhea, and vitamin and mineral losses.

Diagnostic examinations will be conducted and used to evaluate the patient's recovery in regard to electrolyte balance, nutritional status, and vitamin and mineral absorption. Patients who have a colon malignancy are usually asked to return every 3 months for a carcinoembryonic antigen (CEA) test. This examination can detect tumor recurrence.

Surgical resection is the treatment for many large intestine disorders.

Expectations are that the patient who has had a bowel resection (hemicolectomy) for a benign condition or an early malignancy will usually return to normal bowel function within a few months. The patient who undergoes a massive resection and a colostomy or ileostomy will require detailed rehabilitation. "Ostomy" procedures result in the need for patients to wear a collection bag for stool and to be taught how to manage their care. Herniation of the colostomy is fairly common after a few years and refashioning may be required. Referral to a support group and counseling may be needed to help adjustment to the body image. Lastly, radiation and chemotherapy may be necessary ongoing cancer therapy.

• None.

• Where residual adhesions constitute the predominant disability, rate under diagnostic code 7301.

• Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. [38 CR 4.114]

• There are diseases of the digestive system, particularly within the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia and disturbances in nutrition. Consequently, certain coexisting diseases in this area, as indicated in the instruction under the title “Diseases of the Digestive System,” do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in 38 CFR 4.14.  [38 CFR 4.113]