06 surgical disease colon and rectum tutorial hajhamad m msu

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 )

May 1, 2023Diseases of colon and rectum

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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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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.


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



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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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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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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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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

THANK

YOU

06 surgical disease colon and rectum tutorial hajhamad m msu

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Transcript of 06 surgical disease colon and rectum tutorial hajhamad m msu