5. Surgery of the Rectum and Anus Flashcards
What are the different types of rectal prolapse?
-Complete which includes all the layers -Incomplete just the mucosa
A rectal prolapse is usually secondary to _______
tenesmus
Really important to differentiate rectal prolapse from this other prolapse issue (name it) because they are treated entirely differently? How do we do differentiate and if you can say it’s the un-named issue what does that indicate?
Prolapsed intussusception use a probe test to ddx (finger) Use your finger to probe between the border of the prolapse tissue and the anus if that probe(finger) can pass on the sides of the prolapsed tissue that’s a intussusception and it’s a surgical emergency abdominal surgery (r and A, manual reduction) if the probe can’t be passed it’s a rectal prolapse
Rectal prolapse can be caused by these 3 things and you need to treat the underlying cause
-megacolon, prostatic disease, parasites treat these first or it will reoccur
If the rectal prolapse still has viable tissue and looks healthy what can you do and how long does this need to be maintained for? What if reoccurance occurs what can you do?
Reduce and place a purse string suture is viable dont make so tight that it cant shit!!!! maintain this for 3 days, if reoccurance colopexy
If the rectal prolapse still has nonviable tissue or covered in dirt what can you do?
Amputate is non viable
What are some complications for rectal prolapse amputation (4)
- Infection (lots of bacterial)
- Dehiscence
- Stricture
- Reoccurance (even if amputation and they continue to strain)
What are 2 indications for colopexy?
- Recurrent rectal prolapse
- Perineal hernia
What are some different suturing techniqes for colopexy? What is incisional colopexy
- Absorbable or nonabsorbable as long as you arent using full thickness bites for backteria to take up and cause infection for (NA)
- Incisional colpexy- absorbable suture material
DO we enter the mucosa in an incisional colopexy?
NO we don’t enter the lumen!!! Incision through seromuscular layers of the colon and transversus abdominus of the body wall on the LEFT SIDE
similar to incisional gastropexy
We perform incisional colopexy’s on whichcolonic segment and apply this to help keep it in?
descending colon and apply cranial traction to make sure its not going out prolapsing keeping it internal
When we perform a gastropexy it’s sutured in ____ place versus a incisional colopexy?
gastropexy one place, incisional colopexy can perform in more than one spot on descending colon
What are the benign and malignant tumors for colorectal neoplasia
Benign
- Adenomatous polyps can transform into malignant forms
- Leiomyoma
- Fibroma
Malignant
- Adenocarcinoma
- Leiyomyosarcoma
- Lymphosarcoma
Rectal adenomas are benign or malignant? What are the CS and where do most occur in the body?
- Benign!
- MOST OCCUR in distal rectum
CS
- Hematochezia (blood in feces streaks of blood on top surf)
- Tenesmes(sensation that you constantly have to defecate)/dyschezia(constip) (straining from presence of the tumor stimulating
- Visible mass (may be intermittent)
What are the different morphological presentations of rectal adenomas and where do they most commonly occur?
- Polypoid-pedunculated or polyp like
- Sessile-broad based
- Multiple-more than one
- Most commonly occur in the DISTAL RECTUM
What are some different ways to diagnose rectal adenoma?
- Direct obs
- Rectal palpation
- Proctoscopy(rectum) all the way up to colon with a colonoscopy because there can be multiple
- Biopsy through colonoscopy taking small mucosal biopsies
When taking biopsies for rectal adenoma, Biopsy through colonoscopy and take small mucosal biopsies for predx, what should you always do even when preop biopsy is performed and why?
ALWAYS submit excised masses full thickness even when preop biopsy is performed because up to 25% will come back as a more aggressive tumor (carcinoma in situ, invasive adenocarcinoma)
What approaches can you take for rectal adenoma?What is the limiting factor for one of these types of treatment
- Surgical excision
- Transanal
- Dorsal approach
- Mucosal resection only versus full thickness
- Cryosurgery
- Can’t evaluate the margins make sure you dont leave tumor cells behind especially if changed from adenoma or carcinoma insitu (locally aggressive) and adenocarcinoma which is more aggressive in multiple locations
- Can’t confirm dx
With colorectal adenocarcinoma, approximately 50% are _______ and have a napkin ring affect which means?
abdominal, the adenocarcinoma come and stricutre around that portion of colon.
With colorectal adenocarcinoma, lesions are _____, _____, and _____(napkin ring). There may be multiple so examine the entire colon and metastasis to _____ and _______
With colorectal adenocarcinoma, lesions are luminal, intraluminal and annular(napkin ring). There may be multiple so examine the entire colon and metastasis to regional LNs and liver.
Describe the anal surgical approach to the rectum and colorectal junction?
Lesions involving caudal rectum or anal canal
Describe the dorsal surgical approach to the rectum and colorectal junction
Lesions involving midrectum but NOT the anal canal perform incision dorsal to anus
Describe the rectal pull through surgical approach to the rectum and colorectal junction
Distal colonic or midrectal lesion not approachable through abdomen, pull rectum out toward you and be careful not to cut the external anal sphinctor (mild fecal incontinence temporarily)
Describe the swensons pull through surgical approach to the rectum and colorectal junction
lesions that extend beyond peritoneal reflection into abdominal cavity and combines the anal and ventral approach
