COLORECTAL SURGERY BLOG

Crohn’s Disease – Operative Intervention

Inflammatory bowel disease, specifically Crohn’s disease and ulcerative colitis, is thought to result from an abnormal immune regulatory process. Whereas ulcerative colitis is a mucosal inflammation confined to the colon, Crohn’s disease may involve transmural inflammation of any portion of the intestinal tract from the mouth to the anus. Non-caseating granulomas are the hallmark pathological finding in Crohn’s disease. Common symptoms such as diarrhea, abdominal pain or weight loss may be controlled using a variety of medications including antidiarrheal medications, 5-aminosalicylates, steroids, immunosuppressive agents, or anti-tumor necrosis factor antibodies.

Colon & Rectal Surgery Overview

It appears that early detection and removal of pre-malignant polyps, or frank malignancies, has resulted in an overall decreased death rate from cancers of the colon and rectum. From 1990 to 2003, the endpoint of the study period, the death rate attributable to colon and rectal cancer in men decreased 2.1% annually.

Ulcerative Colitis – Operative Intervention

Ulcerative colitis and Crohn’s Disease are the two primary subclassifications of inflammatory bowel disease. Neither entity has a known etiology. However, abnormal immune regulation seems to play a causative role. Both Ulcerative Colitis and Crohn’s disease are thought to be autoimmune in origin. Ulcerative Colitis is defined by mucosal inflammation limited to the rectum and colon. Crohn’s Disease – may involve transmural inflammation of all layers of the bowel wall and can affect any portion of the gastrointestinal tract from the mouth to the anus.

Flatulence

Flatus, or gas is an expected and natural by-product of the normal functioning of the gastrointestinal tract. On average, between one half to two liters of gas are produced daily. This gas is eliminated through the anus approximately fourteen times per day.

The formation and elimination of flatus while normal, may be both uncomfortable and embarrassing and may be the source of laughter, concern or curiosity.

Colon and Rectal Cancer – Polyp Surveillance

Approximately 150,000 new cases of colorectal cancer are diagnosed each year in the United States. It is the second leading cause of cancer mortality, resulting in almost 60,000 deaths every year.1 Cancers of the colon and rectum most commonly develop from precursor adenomatous polyps that increase in size over time.2,3 Early detection and removal of these premalignant polyps usually prevents them from developing into invasive cancer.4,5 This is the rationale behind the colorectal cancer screening recommendations from the American Cancer Society.

Flat Colon Polyps

It is now accepted that most colon cancers originate from benign colon polyps. The cancer-to-polyp sequence is the driving force behind colon screening to find and remove polyps before they transform into a malignancy. There is a unified set of screening guidelines that address the age of first screening, the frequency of screening and the method of screening. This screening has been effective in achieving the stated goal of reducing the number of new colon malignancies detected per year.

Anal Intraepithelial Neoplasia (AIN) & HPV

The term Anal Intraepithelial Neoplasia (AIN) describes the microscopic finding of dysplastic, non-malignant cells in the anal canal. AIN has been subdivided into AIN I, II, and III, representing low, moderate, and high-grade dysplasia. This dysplasia has been thought to arise as a result of local infection with the Human papillomavirus. The Human papillomavirus is a small double-stranded DNA virus with a diameter of 55 nm. and is encased in a protein capsid. The term AIN has gradually replaced other descriptive terminology such as atypical squamous cells of indeterminate significance (ASCUS), low-grade squamous intraepithelial lesions (LSIL), or high-grade squamous intraepithelial lesions (HSIL).

Pilonidal Disease – For Physicians

Pilonidal disease represents several forms of a single abnormality. Pilonidal disease may consist of nothing more than asymptomatic midline skin pits overlying the sacrococcygeal area. At the other extreme, the disease may be a large complex abscess associated with sepsis. In between these extremes are sinuses which occasionally cause discomfort and erythema, or sinuses which periodically drain and then return to an asymptomatic state.

Colon & Rectal Cancer – Genetics & Heredity Overview – Part 1

Alert to the genetics and findings in patients with hereditary colorectal cancer syndromes, physicians may be better able to diagnose and recommend treatment for the colonic manifestations of each disease.

With a myriad of vexing abbreviations and obscure terminology, the genetics controlling the formation of colonic polyps and malignancies may be difficult to appreciate. A review of these colonic disorders will aid in an understanding of the underlying genetics.

Colon & Rectal Cancer – Genetics & Heredity Overview – Part 2

Approximately five per cent of patients with colorectal cancer have an inherited or hereditary mutation in the APC gene, a gene known to be associated with cancer development. Many of the high-risk mutations which lead to colorectal cancer can be located on individual genes using genetic sequence testing. At present however, clinical genetic manipulation cannot reduce the risk of disease development in individual patents.