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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

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Colon rectum and anus diseases l.jpg

Colon, Rectum and Anus Diseases

Boris Vinogradsky, MD

Medical College of Ohio

Department of Surgery


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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?


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Colon, Rectum and Anus Diseases

Evaluation:

  • AAS

  • Sigmoidoscopy

    ICU for IVF/blood, abx, high dose steroids

    Close observation and repeat PE


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Colon, Rectum and Anus Diseases

  • Medical management

    • Azulfadine

    • Prednisone

    • Steroid and/or Sucralfate enemas

    • Imuran/6-MP

    • Low residue diet

    • Lomotil (cautiously)


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Colon, Rectum and Anus Diseases

  • Surgery

    • Subtotal colectomy with ileostomy

    • Ileostomy with “blow-hole” transverse colostomy

    • Continue evaluation

      • Ba enema

      • UGIS with SBFT


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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


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Colon, Rectum and Anus Diseases

  • Causes:

    • Cancer

    • Diverticulitis

    • Volvulus

    • Colonic pseudo obstruction

    • Ischemic colitis


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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)


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Colon, Rectum and Anus Diseases

  • Causes:

    • Upper GI bleeding

    • Diverticulosis

    • Angiodysplasia

    • Cancer


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Colon, Rectum and Anus Diseases

  • Conservative management

  • Surgery

    • Segmental resection

    • Hemicolectomy with 1 anastomosis or MF/colostomy

    • Subtotal colectomy (rare)


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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


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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


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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)


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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)


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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


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Colon, Rectum and Anus Diseases

  • 48 yo wf s/p hysterectomy presents with pneumaturia

  • Diagnosis?

  • Best study?

  • Treatment?


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