IBD Surgery Flashcards
types of emergency surgery?
“planned emergency” - sub-total colectomy for UC or resection of crohns disease
unexpected finding “surprise” operation - diagnostic laparoscopy or rectal/anal disease
elective operations in crohns?
resection
stricturoplasty
fistulas
anal disease
elective operations in UC?
proctocolectomy with end ileostomy
proctocolectomy with ileorectal anastamosis
ileostomy vs colostomy?
ileostomy = terminal ileum is diverted through the abdomen, (colon removed) colostomy = colon diverted through the abdomen (terminal colon/rectum etc removed)
indications for elective surgery in UC?
medically unresponsive disease intolerability dysplasia/malignancy growth retardation in children attempted resolution of extra-intestinal disease
options for elective surgery in UC?
elective proctocolectomy
with end ileostomy/pouch/ileorectal anastamosis
when are pouches used?
popular with young patients
creates a resevoir
types of pouch?
W pouch
J pouch
S pouch
functional outcomes of a pouch?
pouch is not a rectum
patients can have average of 6 bowel movements a day
can have leakage and spotting
immediate complications of proctocoloectomy with pouch?
haemorrhage, enterotomy
anaphylaxis
early complications of protocolectomy with pouch?
urinary dysfunction wound infection pelvic abscess anastamotic leak atelectasis ileus portal vein thrombosis
late complications of proctocolectomy with pouch?
impotence infertility pouchitis DVT/PE small bowel obstruction
what is truelove and witt criteria?
assessment of severity of acute UC
- ESR
- haemaglobin
- bloody stools
- temp
- HR
truelove and witt mild UC criteria?
<4 bowel movements spots of blood in stool normal temp HR<90 no anaemia ESR <30
mod UC?
4-6 bowel movements mild-severe blood in stool normal temp HR<90 no anaemia ESR <30
severe UC criteria?
>6 bowel movements blood in stool high temp HR >90 anaemia ESR >30
what is subtotal colectomy?
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
why is the rectum problematic?
contains the nervi erigenti
how is the rectum managed in general?
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)
is there a cancer risk in IBD?
small increased risk in UC
unclear in crohns
what is toxic megacolon?
complication of UC
involves sepsis, distension and potential perforation of the colon
very painful and requires decompression
can be fatal
describe crohns surgery
laparoscopic approach
extraorporeal anastamosis
indications for crohns surgery?
stenosis causing obstruction enterocutaneous fistula intra-abdominal fistulas abscesses bleeding (acute or chronic) free perforation
how is gastroduodenal disease managed in crohns?
gastrojejunostomy for duodenal or pyloric stenosis
how can multi-site disease be managed in crohns?
stricturoplasty of lesions instead of resection
balloon dilation
types of fistulating disease?
enterocutaneous
intra-abdominal
how are post-op fistulae managed?
usually close with conservative measures unlike active disease causing spontaneous fistulae
vacuum assisted drains may help
management of intra-abdominal fistulae?
resect en-bloc primary defect and close secondary organ
fistula management?
seton stitch
surgery (lay open or stoma for severe disease)
