COLON Volvulus

VOLVULUS

Volvulus of the colon results from rotation of a segment of bowel

on its mesenteric axis sufficient to produce partial or  complete

obstruction of the lumen.

5.1 SIGMOID VOLVULUS

CLINICAL MANIFESTATIONS

Symptoms  are  intermittant,  cramping  lower  abdominal  pain,

abdominal  distension,  obstruction  and absence  of  passage  of

flatus.

Nausea, vomiting and dehydration occur after several hours.

Treatment is by passing a flatus tube through a sigmoidoscope.

In  unsuccessful,  a  laparotomy  is  required  to  derotate  the

volvulus.

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COLON RECTUM CA TREATMENT

TREATMENT

All  lesions  of  the colon need radical  resection  by  no-touch

isolation technique with primary anastomosis Fig. 19.3 a.

Operations  of Rectal Carcinoma - Anterior resection may be  done

if  the  lesion can be resected with a 1 cm.  distal  margin  and

primary anastomosis with the distal segment.  In all other cases,

abdominoperineal  resection  is  done with  left  sided  terminal

colostomy.

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CARCOINOMA COLON RECTUM 3 Clinical menifestation,Diagnosis

CLINICAL MANIFESTATIONS

The  clinical presentation is of abrupt onset in about  one-third

and may run a fulminant course in 10%.

*  Persistent  diarrhoea, preceded by lower abdominal  cramps  is

   the usual complaint.

*  Small stools recurring 20 to 30 times per day.

The diarrhoea produces

*  Dehydration

*  Hypokalemia

*  Anaemia

*  Hypoproteinemia

*  Marked weight loss

*  Relapsing  form with remissions is also  common.   Recurrences

   are  associated  with  emotional  stress,  physical   fatigue,

   respiratory infections and other acute illness.

*  Lower abdominal cramping is always present.

COMPLICATIONS

*  Electrolyte deficiencies

*  Microcytic anaemia

*  Arthritis

*  Arthralgias

*  Spondylitis

Colonic complications include gross haemorrhage

*  Stricture formation

*  Partial obstruction

*  Perforation may occur in the course of the disease

LATE COMPLICATIONS

Late complications also include toxic megacolon and carcinoma  of

the colon.

DIAGNOSIS

Colonoscopy Sigmodoscopy  including  rectal  biopsy  and  Barium  enema   are

important in arriving at a diagnosis (Fig. 19.2).

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Carcinoma colon rectum 2

PATHOLOGY

Carcinomas  of the colon and rectum occur in the various  regions

of  the  large  gut in the  following  propoertions  :  Cecum-8%,

ascending colon-6%, hepatic flexure-2%

Seventy percent colorectal cancers are found in the distal  colon

and  rectum  and  30%  of  all  cancers  can  be  felt  on   P.R.

examination.

*  Polypoidal

*  Nodular

*  Ulcerating or

*  Scirrhus

Fig. 19.3 shows three of these varieties.

MICROSCOPICALLY

Carcinomas   resemble  the  parent  tissue  in  varying   degree,

depending  on  the degree of differentiation  of  the  neoplastic

cells.

In  well-differentiated tumors, the cells are grouped  in  acinar

clusters and look like normal glands.

In  poorly differentitated or anaplastic tumours, the cells  with

little or no resemblance to colonic mucosa cells are  distributed

in irregular sheets or cords.

The  cells  show  malignant  characteristics  of  "pleomorphism",

hyperchromatism, large vesicular nuclei and frequent mitoses.

Carcinoma   spreades  by  direct  extension,  by   lymphatic   or

bloodstream  dissemination,  by  gravitational  seeding  and   by

implantation at operation.

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Carcinoma Coln & Rectum 1

 CARCINOMA OF COLON AND RECTUM

INCIDENCE

It  is  a  common cancer in the West.   Colorectal  carcinoma  is

usually a disease of older persons in the seventh decade.  A high

fibre content of diet has a protective effect on the incidence.

The  incidence  is  low in India since our diet  has  high  fibre

content.

ETIOLOGY

Colorectal carcinoma can develop in patients affected by

-  familial polyposis

-  Gardener's syndrome

-  Villous tumours

-  chronic ulcerative colitis

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