18. Surgical aspects of colorectal polyps, polyposis syndromes, diverticulosis

Question 1

Non-neoplastic polyps

Answer 1

Hyperplastic polyp, juvenile polyp (hamartomas)

90% of cases

Question 2

Neoplastic polyps

Answer 2

Tubular adenoma, villous adenoma, tubulovillous

adenoma, sessile serrated adenoma

Question 3

Polyps symptoms

Answer 3

• bleeding
• asymptomatic
• abdominal pain
• constipation
• diarrhea

Question 4

Polyp diagnosis

Answer 4

fecal occult blood test, endoscopy, digital rectal examination

Question 5

Polyposis syndromes

Answer 5

FAP (familial adenomatous polyposis)

Peutz-Jeghers syndrome (hamartomatous polyps)

Question 6

FAP treatment

Answer 6

Rectum involved -> Rectum + part/all of colon is removed (ileostomy)

Rectum not involved -> Partial colectomy (long healing, but better quality of life)

Prophylactic colectomy if more than 100 polyps, several dysplastic polyps or many over 1 cm

Question 7

Peutz-Jaeghers syndrome

Answer 7

Often first presents with bowel obstruction from
intussusception

Polyp resection if bleeding or intussusception, heavily involved intestinal segments can be resected, colonoscopy to snare polyps if in reach

Question 8

Diverticulosis basics

Answer 8

Several outpouchings of the gut wall, usually where arteries enter

can be aquired or congenital

Inflammation: diverticulitis

Question 9

Diverticulitis symptoms

Answer 9

altered bowel habit, left sided colic relieved by defecation, nausea, flatulence

Question 10

Diverticulitis diagnosis

Answer 10

Colonoscopy (perforation risk), CT abdomen

Question 11

Stages of diverticulitis

Answer 11

Stage 1 – pericolic or mesenteric abscess: rarely needs surgery

Stage 2 – walled off/pelvis abscess: may resolve without surgery

Stage 3 – generalized purulent peritonitis: surgery required

Stage 3 – generalized fecal peritonitis: surgery required