COLON NEOPLASMS 1

NEOPLASMS

4.1 POLYPS

Juvenile  polyps  occur principally in childrent and  are  always

pedunculated.  They vary in diameter, are spherical reddish-brown

in colour and often covered with mucus.

CLINICAL MANIFESTATION

Uusal  symptom is blood streaking of the stool,  rectal  bleeding

and may present with anemia in the patients.  A colonic polyp can

initiate intussusception.

4.2 FAMILIAL POLYPOSIS

This  is  a  rare  hereditary  disease,  characteristic  by   the

appearance  at  an early age with a large number  of  adenomatous

polyps in the colon and rectum (Fig. 19.3)

Symptoms  are frequent bouts of abdominal pain; passage of  loose

blood-stained  stools.   Large polyps may  prolapse  through  the

anus.  Diagnosis is apparent on sigmoidoscopy and Barium enema.

4.3 GARDNER'S SYNDROME

This  inherited disease is more rare than familial polyposis  and

is characterised by polyposis coli plus osteomas or exostoses  in

the mandible, skull and sinuses.

Besides these lesions Hamartomas Liponas and Carcinoids can  also

occur.

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Colon Benign 2 Colitis

PSEUDOMEMBRANOUS ENTERCOLITIS

Pseudomembranous   Enterocolitis   occurs,   postoperatively   in

patients   receiving  antibiotics  the  patient  develops   sever

diarrhoea, abdominal distension, severe enteritis with  extensive

pseudomembrane  on  the  mucosal  surface.   A  pure  culture  of

Staphylococcus aureus can be obtained from the stools.

More  recently, clostrodium difficlile have been responsible  for

pseudomembranous enterocolitis.

3.3 AMOEBIASIS

Amoebiasis, an infection produced by E. Histolitica also presents

with  ulceration and frequent bowel movement has  been  discussed

earlier in the chapter on tropical diseases (Chapter 6).

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Colon Benign 1 Divericolitis

DIVERTICULOSIS COLI

Diverticula  of the colon are herniations of mucosa  through  the

circular  muscular layer and is met with more often in the  west. 

Contributing  factors  thought  to  be  responsible  are  chronic

constipation,   tissue  degeneration  associated  with  age   and

obesity.

Complications  of diverticulosis are bleeding  and  inflammation,

i.e.  diverticulitis.   Incidence  of  bleeding  in  diverticular

disease varies.  Inflammation in diverticulosis has been reported

to occur in nearby 40% of cases.

CLINICAL PICTURE

Left-sided   appendicitis   like   symptoms   are   the    common

presentation.

Pain  is  nearly always the most prominent  symptom.   Associated

change  in bowel habits, diarrhoea, constipation or  irregularity

of bowel movement.

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ULCERATIVE COLITIS 2

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

Sigmodoscopy  including  rectal  biopsy  and  Barium  enema   are

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

TREATMENT

PRIMARY TREATMENT

Antidiarrhoeal  agents,  most  frequently  lomotin,  kaolin   and

pectin.

Steroids  are used to induce a remission and salazopyrin is  used

to continue the remission.

The steroids can be local acting in the form of suppositories  in

rectal  disease.  Oral steroid are required for colonic  disease. 

Salazpyrin  is  poorly  absorbed and  acts  locally  by  reducing

inflammation  and  thus  preventing relapse.   Those  who  cannot

tolerate the side effects should try mesalazine.

OPERATIVE THERAPY

Indications for emergency surgical intervention include:

*  Uncontrollable haemorrhage

*  Intestinal obstruction

*  Perforation

*  Toxic megacolon

The procedure of choice is total proctocolectomy with a  terminal

ileostony.

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