IBD surgery Flashcards
what is an ileostomy?
procedure where end of ileum is diverted through a stoma in the abdomen
what is a colostomy?
end of large intestine is diverted through a hole in the abdomen
when is elective surgery indicated in UC?
medically unresponsive intolerable dysplasia/malignancy growth retardation in children attempted resolution of extra-intestinal disease
what is the surgery for UC?
proctocolectomy with either:
- end ileostomy
- pouch
- ileorectal anastamosis
what is a pouch in a proctocolectomy?
folded/stapled part of intestine that acts as a reservoir (not a rectum) Popular with younger patients 3 types - J pouch (common) - W pouch - S pouch
what are the problems with a pouch?
not a rectum so still several bowel movements per day
minor incontinence
what complications can arise from proctocolectomy with pouch?
immediate - bleed - enterotomy - anaphylaxis early - urinary dysfunction - wound infection - pelvic abscess - anastomotic leak - atelectasis - ileus - portal vein thrombosis Late - impotence - infertility - pouchitis - DVT/PE - small bowel obstruction
how common are UC emergency surgeries?
20% overall
50% in severe attacks
what surgery is used in emergencies for UC?
subtotal colectomy
what is a subtotal colectomy?
partial resection of large bowel
laparoscopic or open
rectal stump can be brought out as mucous fistula
who would you approach a problem of the rectum?
stay away in acute flare up, only proceed when quiescent
removal of colon tends to settle rectal disease so no rush to act on rectum
Can manage with meds (predfoam enemas etc)
what can a toxic megacolon cause?
sepsis
distension
pain
can perforate and be fatal so requires decompression
what are the indications for surgery in crohns?
stenosis causing obstruction enterocutaneous fistulas intra-abdominal fistulas abscesses bleeding (acute or chronic) Free perforation
what surgery is performed for crohns?
resection
stricturolplasty
what surgery is performed for duodenal or pyloric stenosis?
gastrojejunostomy
connects jejunum to stomach to food bypasses obstruction
who is ileocolic disease common in?
crohns patients
80% will need surgery for it
what surgery is performed for multisite disease (eg. many strictures)?
stricturoplasty
balloon dilation
what is the acronym for protocol in fistulating disease and abscess?
SNAP
- sepsis (remove cause/drain)
- nutrition
- anatomy (imaging etc)
- plan/prolonged hospital stay (procedures)
how are perioperative fistulas treated?
usually close with conservative measures
vacuum assisted drains can help
what is an intra-abdominal fistula and how is it treated?
fistula between any organs of the abdomen (vagina, bladder etc)
May be occult
Resect primary defect and close secondary organ
what is crohns colitis?
form of crohns disease
only inflammation of the colon lining
what surgeries can be performed for crohns colitis?
emergency colectomy segmental colectomy total colectomy panproctocolectomy possibly pouches
what is perianal disease?
Give 3 examples
inflammation at or near the anus
primary lesions - fissure, ulcer
secondary lesions - abscess, tags, fistula
incidental lesions - piles, hidradenitis (inflamed lumps)
how are fistulas treated?
seton is good
surgery
- lay open
- stoma if severe
