Colorectal Surgery!!

Morag Sime and Chloe Hymers

Aims

• Understand hernias- including types and complications

• Know main causes of bowel obstruction, the diagnosis and initial management

• Recognise stomas- colostomy vs ileostomy

Objectives (from your syllabus)

• Recognise the possibility of bowel obstruction• Initiate appropriate investigations and

management• Understand anatomical factors that produce a

potential defect at common hernia sites• Recognise common ways in which hernia present• Detect hernias in ant abdominal wall, inguinal and

femoral region• Recognise common complications of hernias

Hernias

Definition of a hernia:

• A hernia is the protrusion of a viscus or part of a viscus outside the cavity which normally contains it.

Types of hernia

Examining a hernia

• What are you looking for?

Complications of hernias

• Incarcerated • Compromised bowel transit

• Compromised blood supply

• Irreducible• Strangulated

• Obstructed

Complications of complications

• Perfortation

• Peritonitis

• Death

Management

• Conservative:– Reassurance– Watch and wait– Truss– Treat cause (eg??)

• Medical• Surgical

– Mesh repair– +/- Bowel resection

Bowel Obstruction

Main Causes

• How to classify?

• Intraluminal

• Intramural

• Extraluminal

Main Causes

• Intraluminal– Faecal impaction– Gallstone Ileus

• Intramural– Cancer– Diverticular strictures– IBD strictures

• Extraluminal– Adhesions– Hernias– Volvulus– Other cancers

Management of bowel obstruction

• DRIP AND SUCK

• IV fluids• NG tube• Bloods• CXR, AXR ?CT• Catheter• Analgesia (IV)• NBM• Antiemetics• PR

Stomas

Case Study

• A 72 year old man presents with a painful swelling in his right groin. He explains that he has ‘had a lump’ there for years and it’s never given him any trouble before. On examination he has a 4cm tender mass which is not reducible. The skin overlying is dusky coloured. It is located medially and inferior to the pubic tubercle.

Questions

• What are the differentials?

• What investigations would you do?

• What is the initial management?

• Explain having a CT scanner to the patient

• Explain post op care to the patient

Most important things to know for finals…

• 1) Definition of a hernia

• 2) Anatomy of the inguinal canal

• 3) Most common causes of bowel obstruction

Most important things to know for life….

• 1) Is it a dangerous hernia??

• 2) Initial management of bowel obstruction

• 3) Always do a PR

• Any Questions????