Colorectal surgery: Colorectal cancer Flashcards
A 60-year-old man attends the surgical day unit for a loop ileostomy following rectal cancer surgery. He is informed that he will be left with a stoma and that the stoma nurses will explain how this is to be cared for.
What are the correct features of this stoma?
Left iliac fossa, flushed appearance with solid output
Left iliac fossa, spouted appearance with solid output
Right iliac fossa, flushed appearance with liquid output
Right iliac fossa, spouted appearance with liquid output
Right iliac fossa, spouted appearance with solid output
A 60-year-old man attends the surgical day unit for a loop ileostomy following rectal cancer surgery. He is informed that he will be left with a stoma and that the stoma nurses will explain how this is to be cared for.
What are the correct features of this stoma?
Right iliac fossa, spouted appearance with liquid output
Colon has a role in the absorption of water from the gastrointestinal tract, with it being bypassed, the stool will be looser and therefore present as a liquid. As the stool is liquid and rich in digestive enzymes it is more likely to irritate the skin, therefore a spout is preferred so that it can drain directly into the stoma bag. It is often located in the right iliac fossa as the ileocecal junction (the connection between the ileum and cecum) is located in the right iliac fossa. Creating an ileostomy in this area allows for the least disruption of the natural digestive process.
A 45-year-old man presents to his GP with pain around the site of his stoma. The patient appears systemically well. On examination, there is erythema around his stoma site, located in the right iliac fossa. A close examination of the stoma reveals there are two lumens. One lumen appears to be raised above the skin more than the other and is productive of liquid contents. He has a past medical history of a tumour of the ascending colon, which was removed via a segmental resection and subsequent anastomosis.
What is the most likely type of stoma present?
End colostomy
End ileostomy
Loop colostomy
Loop ileostomy
Urostomy
Loop ileostomy
The presence of two lumens in this stoma suggests that it is indeed a loop stoma; end stomas characteristically have only one lumen
How can you tell if a stoma if a loop or closed by inspecting the lumens? [2]
loop stoma; two lumens
end stomas characteristically have only one lumen
A 76-year-old woman presents to the outpatient colonoscopy department following a referral from her GP due to a positive faecal immunochemical test (FIT). Colonoscopy reveals a 3x2 cm mass at the distal end of the transverse colon near the splenic flexure. Histology from a biopsy confirms an isolated adenocarcinoma. Following a multidisciplinary team (MDT) discussion, she is scheduled for surgical resection of the tumour.
What is the most likely surgery that will be performed?
Hartmann’s procedure
Left hemicolectomy
Total colectomy
Transverse colectomy
Wide-local excision of the tumour
A 76-year-old woman presents to the outpatient colonoscopy department following a referral from her GP due to a positive faecal immunochemical test (FIT). Colonoscopy reveals a 3x2 cm mass at the distal end of the transverse colon near the splenic flexure. Histology from a biopsy confirms an isolated adenocarcinoma. Following a multidisciplinary team (MDT) discussion, she is scheduled for surgical resection of the tumour.
What is the most likely surgery that will be performed?
Hartmann’s procedure
Left hemicolectomy
Total colectomy
Transverse colectomy:
- It is generally reserved for tumours situated centrally within the transverse colon, whereas lesions at either end are more appropriately managed with right or left hemicolectomies respectively.
Wide-local excision of the tumour
Question 8 of 113
A 67-year-old man presents to clinic with a history of blood in the stools and weight loss. He was referred for an urgent colonoscopy, which showed a mass in the distal transverse colon. Biopsy confirmed adenocarcinoma. Further investigation reveals no lymph node involvement or distant metastasis.
What surgery should be offered?
Hartmann’s procedure
High anterior resection
Left hemicolectomy
Right hemicolectomy
Total colectomy
Question 8 of 113
A 67-year-old man presents to clinic with a history of blood in the stools and weight loss. He was referred for an urgent colonoscopy, which showed a mass in the distal transverse colon. Biopsy confirmed adenocarcinoma. Further investigation reveals no lymph node involvement or distant metastasis.
What surgery should be offered?
Hartmann’s procedure
High anterior resection
Left hemicolectomy
Right hemicolectomy
Total colectomy
A 78-year-old man presents to the emergency department with intense abdominal pain. He has not passed faeces or wind in the last 48 hours. When asked, he mentions that he has lost some weight recently and in the weeks preceding this event he has been feeling constipated. The team suspects a large bowel obstruction due to cancer and orders a CT scan, that shows a mass in the hepatic flexure.
Which one of the following surgical management plans is the most appropriate for the patient?
Hartmann’s procedure
High anterior resection
Left hemicolectomy
Low anterior resection
Right hemicolectomy
A 78-year-old man presents to the emergency department with intense abdominal pain. He has not passed faeces or wind in the last 48 hours. When asked, he mentions that he has lost some weight recently and in the weeks preceding this event he has been feeling constipated. The team suspects a large bowel obstruction due to cancer and orders a CT scan, that shows a mass in the hepatic flexure.
Which one of the following surgical management plans is the most appropriate for the patient?
Hartmann’s procedure
High anterior resection
Left hemicolectomy
Low anterior resection
Right hemicolectomy
