06 surgical disease colon and rectum tutorial hajhamad m msu
TRANSCRIPT
May 1, 2023
Diseases of colon and rectum 1
DISEASES OF COLON AND
RECTUMDr. Mohammed Hajhamad,
MB.ChB. (MUST - Egypt), M.S (UKM - Malaysia)
Department of SurgeryInternational Medical School
Management and Science University
Introduction …
Introduction …
Rectum Distal part of gastrointestinal
tract It´s about 12 – 18 cm long It´s divided into three parts: 1. proximal part 2. middle part 3. distal part ( anal canal )
Anatomy contd. Blood supply : 1. superior rectal artery ( inferior mesenteric artery )2. two middle rectal arteries ( internal iliac artery )3. two inferior rectal arteries ( internal pudendal artery )
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Functions of colon and rectum Absorption of water and sodium, mainly
right side Reservoir for solid feces, till time of
defecation. Secrets, mucus (lubrication), also
potassium and bicarbonate.
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Intestinal fistulaeDefinition: ….Aetiology:1. 80% iatrogenic after surgery
unrecognized intestinal injuryfailure of intestinal anastomosis (Causes?)
2. 20% other causes- congenital anomalies, patent vittello-intestinal duct.- abdominal trauma (O&G)- inflammatory conditions- malignant tumors
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Intestinal fistulae Complications:
- metabolic - dehydration- malnutrition- electrolyte imbalance- acid-base disturbance- sepsis- skin irritation and maceration
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Intestinal fistulae Management
- resuscitation and skin protection- nutritional support- investigations and eradication of sepsis- definitive treatment
Most fistulae closes spontaneously within 4-6 weeks.If not …. Look for FRIENDS
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Diseases of colon and rectum
Diverticular disease of the colon Definition: pulsion
of the colonic mucosa through the circular muscle layer at the point of entry of the blood vessels between the tenia coli.
Sigmoid colon is the most common part affected.
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Diverticular disease of the colon Aetiology:
- lack of fiber in the diet chronic constipation increased intra-luminal pressure diverticulosis.
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Complications 1. Acute diverticulitis2. Perforation3. Recurrent attacks of acute inflammation4. Bleeding5. Colonic stricture due to chronic
diverticulitis6. Fistula formation (colo-vesical, colo-
vaginal or colo-intestinal)
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Clinical features Usually above 40 Asymptomatic, lower abdominal pain,
distension or flatulence. Mimics appendicitis in acute
diverticulitis. Long history of constipation Fresh bleeding per rectum
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Investigations Barium enema
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Investigations Sigmoidoscopy and
colonoscopy
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Investigations CT scan
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Treatment If only diverticulosis, high fiber diet to
prevent constipation. Acute diverticulitis, depends on severity.
Ranging from IV antibioticsDrainageLaparotomy and resection
Bleeding: ColonoscopyAngioembolisationSurgery
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IBD Usually used to denote Ulcerative colitis
and Crohn’s disease. However, inflammation can be due to
schistosmoal colitis, ameboic colitis, ileocaecal tuberculosis and typhoid enteritis.
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Diseases of colon and rectum
UC vs. CDUC: inflammatory
disease of colon, chch by ulcerations. Unknown aetiology.
CD: (regional ileitis), idiopathic, chronic, transmural, granulomatous inflammatory disease of whole GIT.
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UC vs. CD
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UC vs. CD
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UC vs. CD
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UC vs. CD treatment Medical (sulfasalazin, steroids,
antibiotics …) Surgical
failure of medical treatment to control symptomscomplicated diseases
Colorectal Cancer in Malaysia
Source: Malaysian Cancer Statistics- Data and FigurePeninsular Malaysia 2006
Carcinoma of colon and rectum
Only 40% of colorectal cancers are diagnosed with localized disease.
Carcinoma of colon and rectum
PathogenesisAdenoma-Carcinoma-Sequence (90%)
NormalEpithelia
Hyperprolif. EpithelAberrante crypt-Foci
APC- mutation
COX-2 Expression
K-ras Mutation
p53 Mutation
colorectal carcinomas developwithin 10 –15 years from polyps (Adenoma)
Adenoma Carcinoma
Carcinoma of colon and rectum
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Etiology Solitary villous adenoma Familial polyposis coli, Gardner’s
syndrome Ulcerative colitis Lack of fibers and high animal fat
consumption Uretero-colic anastomosis
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Diseases of colon and rectum
Pathology Adenocarcinoma is
the most common type, can be well, moderately or poorly differentiated type.
2/3rds are in rectum and sigmoid
They spread either direct, lymphatic, blood or transperitoneal.
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Diseases of colon and rectum
Staging
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Complications1. Intestinal obstruction … 20%2. Perforation and formation of fistula3. Bleeding, acute or chronic4. Complications due to spread, jaundice,
liver failure, ascitis.
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Clinical features
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Investigations 1. Blood picture, for anemia2. Sigmoidoscopy or colonoscopy.3. Barium enema4. CT and/or US for staging … ? Liver
metastasis.5. CEA
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Treatment and prognosis
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Volvulus Its twisting of a bowel loop around its
mesenteric axis. It can cause both obstruction and
strangulation. Can lead to perforation and gangrene. Sigmoid is the commonest part. Caecum, stomach and small bowel can
occur.
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Diseases of colon and rectum
Predisposing factorsCommon in elderly with
chronic constipation 1. Long sigmoid2. Narrow base of
sigmoid mesocolon3. Heavily loaded
sigmoid because of constipation
4. Adhesions at the apex of sigmoid facilitate its rotation.
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Clinical features Acute colonic obstruction: distension,
pain and constipation. Neglected cases can perforate and
present with sepsis due to peritonitis.
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Investigations Abdominal X-ray
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Investigation CT scan
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Investigations Sigmoidoscopy
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Treatment Resuscitation Conservative Endoscopic decompression Surgery, sigmoid colectomy +/- colopixy
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Time to wake up
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