Colon, Rectum and Anus Diseases
Boris Vinogradsky, MD Medical College of Ohio Department of Surgery
Colon, Rectum and Anus Diseases
42 yo wm with history of intermittent diarrhea, rectal bleeding and abdominal pain presents to ER with fever of 101.6 F, abdominal distention and WBC of 14.0 Your diagnosis?
Colon, Rectum and Anus Diseases
Evaluation:
AAS Sigmoidoscopy
ICU for IVF/blood, abx, high dose steroids Close observation and repeat PE
Colon, Rectum and Anus Diseases
Medical management
Azulfadine Prednisone Steroid and/or Sucralfate enemas Imuran/6-MP Low residue diet Lomotil (cautiously)
Colon, Rectum and Anus Diseases
Surgery
Subtotal colectomy with ileostomy Ileostomy with “blow-hole” transverse colostomy
Continue evaluation
Ba enema UGIS with SBFT
Colon, Rectum and Anus Diseases
77 yo wf with abdominal distention, obstipation and generalized abdominal pain Evaluation
AAS Sigmoidoscopy Gastrograffin enema CT abdomen and pelvis
Colon, Rectum and Anus Diseases
Causes:
Cancer Diverticulitis Volvulus
Colonic pseudo obstruction Ischemic colitis
Colon, Rectum and Anus Diseases
65 yo wm with massive rectal bleeding
Work-up:
Proctosigmoidoscopy Angiogram (1-3 cc/min) Tagged RBC scan (0.5-1 cc/min)
Colon, Rectum and Anus Diseases
Causes:
Upper GI bleeding Diverticulosis Angiodysplasia Cancer
Colon, Rectum and Anus Diseases
Conservative management Surgery
Segmental resection Hemicolectomy with 1 anastomosis or MF/colostomy Subtotal colectomy (rare)
Colon, Rectum and Anus Diseases
Remember: identification of the site of bleeding is more important than knowing the cause Blind subtotal colectomy is an act of desperation
Colon, Rectum and Anus Diseases
55 yo wf recently developed hemorrhoid-like lesion in the anus and presents with anal discomfort and on and off bleeding
Biopsy Nigro protocol:
XRT 3,000 rads 5 days of chemo (5-FU and Mitomycin C) before and after XRT APR
Colon, Rectum and Anus Diseases
45 yo wm who recently noted blood in stool
Colonoscopy with biopsy of the lesion CXR CT abdomen and pelvis CEA level Transrectal US (rectal Ca)
Colon, Rectum and Anus Diseases
Treatment
Carcinoma limited to mucosa – simple polypectomy Carcinoma with negative LN – resection Carcinoma with positive LN – resection and chemotherapy (5-FU and Levamisole)
Colon, Rectum and Anus Diseases
Follow-up:
Colonoscopy q6 months CXR q3 months Office visits q6 weeks:
Stool guaiac CEA level (what if it is elevated) LFT
Colon, Rectum and Anus Diseases
48 yo wf s/p hysterectomy presents with pneumaturia Diagnosis? Best study? Treatment?