IBD Surgery

Question 1

types of emergency surgery?

Answer 1

“planned emergency” - sub-total colectomy for UC or resection of crohns disease
unexpected finding “surprise” operation - diagnostic laparoscopy or rectal/anal disease

Question 2

elective operations in crohns?

Answer 2

resection
stricturoplasty
fistulas
anal disease

Question 3

elective operations in UC?

Answer 3

proctocolectomy with end ileostomy

proctocolectomy with ileorectal anastamosis

Question 4

ileostomy vs colostomy?

Answer 4

ileostomy = terminal ileum is diverted through the abdomen, (colon removed)
colostomy = colon diverted through the abdomen (terminal colon/rectum etc removed)

Question 5

indications for elective surgery in UC?

Answer 5

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

Question 6

options for elective surgery in UC?

Answer 6

elective proctocolectomy

with end ileostomy/pouch/ileorectal anastamosis

Question 7

when are pouches used?

Answer 7

popular with young patients

creates a resevoir

Question 8

types of pouch?

Answer 8

W pouch
J pouch
S pouch

Question 9

functional outcomes of a pouch?

Answer 9

pouch is not a rectum
patients can have average of 6 bowel movements a day
can have leakage and spotting

Question 10

immediate complications of proctocoloectomy with pouch?

Answer 10

haemorrhage, enterotomy

anaphylaxis

Question 11

early complications of protocolectomy with pouch?

Answer 11

urinary dysfunction
wound infection
pelvic abscess 
anastamotic leak
atelectasis
ileus
portal vein thrombosis

Question 12

late complications of proctocolectomy with pouch?

Answer 12

impotence
infertility
pouchitis 
DVT/PE
small bowel obstruction

Question 13

what is truelove and witt criteria?

Answer 13

assessment of severity of acute UC

• ESR
• haemaglobin
• bloody stools
• temp
• HR

Question 14

truelove and witt mild UC criteria?

Answer 14

<4 bowel movements
spots of blood in stool
normal temp
HR<90
no anaemia
ESR <30

Question 15

mod UC?

Answer 15

4-6 bowel movements
mild-severe blood in stool
normal temp
HR<90
no anaemia
ESR <30

Question 16

severe UC criteria?

Answer 16

>6 bowel movements
blood in stool
high temp
HR >90
anaemia
ESR >30

Question 17

what is subtotal colectomy?

Answer 17

removal of part of the colon
often done as a first aid operation
can be done as an open or laparoscopic procedure
rectal stump can be brought out as a mucous fistula

Question 18

why is the rectum problematic?

Answer 18

contains the nervi erigenti

Question 19

how is the rectum managed in general?

Answer 19

stay away from the rectum in acute flare up, then proceed when stable
removal of colon tends to settle rectal disease
generally managed with meds (predfoam enames etc)

Question 20

is there a cancer risk in IBD?

Answer 20

small increased risk in UC

unclear in crohns

Question 21

what is toxic megacolon?

Answer 21

complication of UC
involves sepsis, distension and potential perforation of the colon
very painful and requires decompression
can be fatal

Question 22

describe crohns surgery

Answer 22

laparoscopic approach

extraorporeal anastamosis

Question 23

indications for crohns surgery?

Answer 23

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

Question 24

how is gastroduodenal disease managed in crohns?

Answer 24

gastrojejunostomy for duodenal or pyloric stenosis

Question 25

how can multi-site disease be managed in crohns?

Answer 25

stricturoplasty of lesions instead of resection

balloon dilation

Question 26

types of fistulating disease?

Answer 26

enterocutaneous

intra-abdominal

Question 27

how are post-op fistulae managed?

Answer 27

usually close with conservative measures unlike active disease causing spontaneous fistulae
vacuum assisted drains may help

Question 28

management of intra-abdominal fistulae?

Answer 28

resect en-bloc primary defect and close secondary organ

Question 29

fistula management?

Answer 29

seton stitch

surgery (lay open or stoma for severe disease)