Colorectal Surgery

Question 1

What are the low risk features of someone with rectal bleeding?

Answer 1

Symptoms have been present less than six weeks
Patient is less than 40 years old
The bleeding has associated anal symptoms

Question 2

What are the high risk features of someone with rectal bleeding?

Answer 2

Symptoms have been present greater than six weeks
There is persistent rectal bleeding without anal symptoms
Right sided abdominal mass
Palpable rectal mass
Unexplained iron deficiency anaemia

Question 3

How long should a patient with low risk factor rectal bleeding be left for before review?

Answer 3

Six weeks

Question 4

What investigations are appropriate in cases of rectal bleeding- and who should get them?

Answer 4

Colonoscopy
Flexible/rigid sigmoidoscopy (with or without barium enema)
CT colonography

Should be carried out on patients with high risk features or patients with low risk features who’s symptoms are persistent or will not deteriorate after six week wait

Question 5

What criteria is important for a successful bowel anastomosis?

Answer 5

Tension free
Well perfused
Well oxygenated
Clean surgical site
Acceptable systemic state

Question 6

What are the potential complications of performing a faecal diversion?

Answer 6

Anaesthetic related 
Bleeding
Sepsis
VTE
Anastomotic breakdown 
Small bowel obstruction 
Wound hernia