IBD surgery

Question 1

what is an ileostomy?

Answer 1

procedure where end of ileum is diverted through a stoma in the abdomen

Question 2

what is a colostomy?

Answer 2

end of large intestine is diverted through a hole in the abdomen

Question 3

when is elective surgery indicated in UC?

Answer 3

medically unresponsive
intolerable
dysplasia/malignancy
growth retardation in children
attempted resolution of extra-intestinal disease

Question 4

what is the surgery for UC?

Answer 4

proctocolectomy with either:

• end ileostomy
• pouch
• ileorectal anastamosis

Question 5

what is a pouch in a proctocolectomy?

Answer 5

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

Question 6

what are the problems with a pouch?

Answer 6

not a rectum so still several bowel movements per day

minor incontinence

Question 7

what complications can arise from proctocolectomy with pouch?

Answer 7

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

Question 8

how common are UC emergency surgeries?

Answer 8

20% overall

50% in severe attacks

Question 9

what surgery is used in emergencies for UC?

Answer 9

subtotal colectomy

Question 10

what is a subtotal colectomy?

Answer 10

partial resection of large bowel
laparoscopic or open
rectal stump can be brought out as mucous fistula

Question 11

who would you approach a problem of the rectum?

Answer 11

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)

Question 12

what can a toxic megacolon cause?

Answer 12

sepsis
distension
pain
can perforate and be fatal so requires decompression

Question 13

what are the indications for surgery in crohns?

Answer 13

stenosis causing obstruction
enterocutaneous fistulas
intra-abdominal fistulas
abscesses
bleeding (acute or chronic)
Free perforation

Question 14

what surgery is performed for crohns?

Answer 14

resection

stricturolplasty

Question 15

what surgery is performed for duodenal or pyloric stenosis?

Answer 15

gastrojejunostomy

connects jejunum to stomach to food bypasses obstruction

Question 16

who is ileocolic disease common in?

Answer 16

crohns patients

80% will need surgery for it

Question 17

what surgery is performed for multisite disease (eg. many strictures)?

Answer 17

stricturoplasty

balloon dilation

Question 18

what is the acronym for protocol in fistulating disease and abscess?

Answer 18

SNAP

• sepsis (remove cause/drain)
• nutrition
• anatomy (imaging etc)
• plan/prolonged hospital stay (procedures)

Question 19

how are perioperative fistulas treated?

Answer 19

usually close with conservative measures

vacuum assisted drains can help

Question 20

what is an intra-abdominal fistula and how is it treated?

Answer 20

fistula between any organs of the abdomen (vagina, bladder etc)
May be occult
Resect primary defect and close secondary organ

Question 21

what is crohns colitis?

Answer 21

form of crohns disease

only inflammation of the colon lining

Question 22

what surgeries can be performed for crohns colitis?

Answer 22

emergency colectomy
segmental colectomy
total colectomy
panproctocolectomy
possibly pouches

Question 23

what is perianal disease?

Give 3 examples

Answer 23

inflammation at or near the anus
primary lesions - fissure, ulcer
secondary lesions - abscess, tags, fistula
incidental lesions - piles, hidradenitis (inflamed lumps)

Question 24

how are fistulas treated?

Answer 24

seton is good
surgery
- lay open
- stoma if severe