Colon, Rectum and Anus Diseases

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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?