colo rectal bleeding colorectal bleeding: a multidisciplinary approach first joint meeting with mayo...
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Colo rectal bleedingColo rectal bleeding
Colorectal Bleeding:Colorectal Bleeding:A Multidisciplinary ApproachA Multidisciplinary ApproachFirst Joint Meeting with Mayo Clinic and University of MinnesotaFirst Joint Meeting with Mayo Clinic and University of Minnesota
Colo rectal bleeding (minor Chronic)Colo rectal bleeding (minor Chronic)
Dott. Edoardo Formento Dott. Edoardo Formento Dott.ssa Elisabetta RadiceDott.ssa Elisabetta Radice
Università degli Studi di Torino
Azienda Sanitaria Ospedaliera MolinetteS.Giovanni Battista di Torino
Torino, 31 Marzo – 1 Aprile 2006
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Patients evaluation and diagnosisPatients evaluation and diagnosis
1.1. Clinical HistoryClinical History
2.2. Physical examPhysical exam
3.3. AnoscopyAnoscopy
4.4. Rigid SigmoidoscopyRigid Sigmoidoscopy
5.5. Flexible SigmoidoscopyFlexible Sigmoidoscopy
Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006
Clinical HistoryClinical History
AgeAge
Family history for Family history for cancercancer
Kind of bleedingKind of bleeding
ColourColour
QuantityQuantity
FrequencyFrequency
Relation to defecationRelation to defecation
Clinical Clinical HistoryHistory
11 Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006
Symptoms associatedSymptoms associated ConstipationConstipation DiarrheaDiarrhea Abdominal painAbdominal pain AnorexiaAnorexia Weight lossWeight loss Addominal massAddominal mass
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Addominal massAddominal mass
Inguinal linfglandsInguinal linfglands
Perineal examPerineal exam
Physical Physical examexam
22 Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006
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Addominal and Perineal examAddominal and Perineal exam
InspectionInspection
PerinealPerineal DermatosisDermatosis Prolapsing haemorrhoidsProlapsing haemorrhoids Rectal prolapseRectal prolapse Solitary rectal ulcerSolitary rectal ulcer Anal cancersAnal cancers Sexual transmitted diseasesSexual transmitted diseases
AnalAnalFissuresFissures
Physical Physical examexam
22 Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006
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Rectal digital examinationRectal digital examination
Anal canalAnal canal
Rectal ampulla till 8-10 cmRectal ampulla till 8-10 cm(better then endo us?)(better then endo us?)
Anorectal spacesAnorectal spaces
Anal sphincter complexAnal sphincter complex
Pelvic massPelvic massPhysical Physical
examexam
22 Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006
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AnoscopyAnoscopy
Anal canalAnal canal
Dentate lineDentate line
AnodermAnoderm
AnoscopAnoscopyy33 Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006
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Rigid sigmoidoscopyRigid sigmoidoscopy
IndicationsIndications assesment in youg people with bleeding (under assesment in youg people with bleeding (under
40 years old)40 years old) to mesure the exact distance of a rectal tumor to mesure the exact distance of a rectal tumor
from the anal vergefrom the anal verge to give the precise location of the lesion on the to give the precise location of the lesion on the
wallwall follow up of patients treated for rectal follow up of patients treated for rectal
adenomas and rectal canceradenomas and rectal cancer follow up of patients with aspecific proctitisfollow up of patients with aspecific proctitis
RigidRigidSigm.Sigm.
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Flexible sigmoidoscopyFlexible sigmoidoscopy
PreparationPreparation ( 2 enemac 4 and 2 hours bifore) ( 2 enemac 4 and 2 hours bifore)
Reaches the splenic flexure 80%Reaches the splenic flexure 80% (M.Sleisenger, Gastrointestinal and liver disease, 2002)(M.Sleisenger, Gastrointestinal and liver disease, 2002)
Why?Why? 33% right colon cancer diagnosed for anemia33% right colon cancer diagnosed for anemia
30% “ “ “ “ “ addominal mass30% “ “ “ “ “ addominal mass 36% “ “ “ “ “ rapid loss weight36% “ “ “ “ “ rapid loss weight
1% “ 1% “ “ ““ “ “ “ massive haemorrhage “ “ massive haemorrhage (S.Kelly ,Queen Alexandra Hospital, Porthsmouth 2003)(S.Kelly ,Queen Alexandra Hospital, Porthsmouth 2003)
Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006
FlexibleFlexibleSigm.Sigm.
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Flexible sigmoidoscopyFlexible sigmoidoscopy
IndicationsIndications All patients age > 40 years oldAll patients age > 40 years old All patients age < 40 years old:All patients age < 40 years old:
With an adenoma or carcinoma of the colon in With an adenoma or carcinoma of the colon in their history out follow-up.their history out follow-up.
With a carcinoma in any other organ; as in With a carcinoma in any other organ; as in colorectal cancer HNPCC associated (endometrio, colorectal cancer HNPCC associated (endometrio, gastric and small bowel carcinoma).gastric and small bowel carcinoma).
With positive family history for colon cancer: With positive family history for colon cancer: relative of 1st degree (if 45-55 years old risk > 3, if relative of 1st degree (if 45-55 years old risk > 3, if 45 years old risk > 4). If relative of 2nd degree the 45 years old risk > 4). If relative of 2nd degree the risk increases more less.risk increases more less.
With proctocolite already diagnosed.With proctocolite already diagnosed. FlexibleFlexibleSigm.Sigm.
55 Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006
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Rectal bleeding unitRectal bleeding unit
Positions for ispectionPositions for ispection Left lateralLeft lateral
JackknifeJackknife
Trolley for proctologyTrolley for proctologyAnoscopyAnoscopy
SigmoidoscopySigmoidoscopy Rubber band ligationRubber band ligation BiopsyBiopsy
VideocolonoscopyVideocolonoscopy
Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006
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Colo
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Colorectal bleeding (minor chronic)Colorectal bleeding (minor chronic)
Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006
Conclusions 1Conclusions 1
The goal of the meeting is to demonstrate The goal of the meeting is to demonstrate the importance for the surgeons who the importance for the surgeons who treat the rectal bleeding (haemorrhoids treat the rectal bleeding (haemorrhoids and colorectal adenoma and carcinoma) and colorectal adenoma and carcinoma) to use the modern flexible to use the modern flexible sigmoidoscope and colonscope.sigmoidoscope and colonscope.
For assessment and treatment.For assessment and treatment.
Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006
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Conclusions 2Conclusions 2
Unit of Physiology 1970Unit of Physiology 1970 Sir Alan ParksSir Alan Parks St. Mark’s HospitalSt. Mark’s Hospital European school of colorectal surgeryEuropean school of colorectal surgery
Unit of Rectal Bleeding 1980Unit of Rectal Bleeding 1980 Stan GoldbergStan Goldberg S.NivatvongsS.Nivatvongs University of Minnesota University of Minnesota American School of Colorectal SurgeryAmerican School of Colorectal Surgery
Colorectal Bleeding: a Multidisciplinary Approach – Turin, March 2006
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