colonf

anatomy

anatomy

Arterial blood supply

Venouse outflow

Intraparietal lymphatic vessels

Lymphatic drainage

Differences of the right and left half
Anatomy: on the right the lumen is wider, than at the left (except for the ileocecal valve)
Contention on the right is liquid, at the left dense
Tumours on the right is more often exophytic, at the left endophytic
Exophytic tumours destroyed with a bleeding more often

Special investigation methods
1. Physical investiga-tion
2. A proctosigmoido-scopy
3. Fibrocolonoscopy

Colonoscopy - an initial cancer

Modern colonoscopy

Special investigation methods
4. irrigoscopy (including virtu-al)
5. abdominal cavity US
6. radial methods (CТ, PET, etc.)
7. laparoscopy
8. intravenous urography
9. reactions to an occult blood
10. cancer markers

Virtual colonoscopy

At what a cancer localization more often
anemy?

At what a cancer localization more often
Visible bleeding?

AT WHAT A CANCER LOCALIZATION MORE OFTEN
Disturbance
of passability

AT WHAT A CANCER LOCALIZATION MORE OFTEN
Perforation is more possible?

AT WHAT A CANCER LOCALIZATION MORE OFTEN
Fistulas, phlegmons are possible?

Colon cancer localisation

Cancer clinical signs
1. Functional signs without intestinal disorders (a pain, etc.)
2. Intestinal disorders (diarrheas, con-stipations, alternating)
3. Disturbances of intestinal passabi-lity
4. Pathological discharge
5. Disturbance of the general conditi-on of patients
6. Palpating detection of a tumour

Cancer clinical forms
1) toxico-anemic
2) enterocolitic
3) dyspeptic
4) obturational
5) pseudo-inflammatory
6) tumoral

Colon cancer diagnosis

Colon cancer diagnosis

TNM

TNM - T
Tx - the estimation of a primary tumour is impossible
T0 - the primary tumour is not found out
Tis - a cancer in situ: cancer cells find out within the limits of a basal membrane of glands or in own plate of a mucous membrane

T1 – The tumour amazes
a submucouse layer

T2 - the tumour spreads into
a muscular layer

Т3 - the tumour gets into a subserous layer or not covered by a paracolitis and pararectal peritoneum fat

Т4 - the tumour amazes the neighboring organs and tissues and/or spread through a visceral peritoneum

N1 - it is amazed from 1 up to 3 regional lymphonoduses

N2 - it is amazed 4 and more regional lymphonoduses

Manual suturing of an intestine

Staplers

Hardware seam

Hardware seam

Left half resection (hemicolectomy)

Right half resection (hemicolectomy)

Transversum resection

Type Hartmann resection

Terminal flat colostomy on E.G.Topuzov

Terminal flat colostomy on E.G.Topuzov

Terminal flat colostomy on E.G.Topuzov

Terminal flat colostomy on E.G.Topuzov

E.G.Topuzov's updating of Hartmann type operation

Double-barrelled colostomy

Colostomy formation places

stenting

stenting

complications
The intestinal obstruction is most typical for a tu-mor localization in the colon left half or in a sigmo-id intestine (here is more often marked endophytic tumour growth, fecal masses more dense, diame-ter of an intestine is less). The principal cause of an obstruction - narrowing of an intestine lumen, but sometimes it causes an invagination of an intestine at exophytically growing tumour or volvulus of the intestine amazed by a tumour. Harbingers of deve-lopment of an obstruction are the constipations, replaced diarrheas, rumbling in an abdomen, a pe-riodic abdominal distention.

complications
The inflammation in tissues surrounding a tumour (up to phlegmon or abscess de-velopment) is marked at 8-10% of patients. It is more often marked at tumours of caecum and ascending colon.

Question
Pain in the right ileal region, a tumour and a heat.
With what diseases you should differentiate?

complications
Perforation of an intestine can be as in a zone of the tumour, at its disinte-gration or a ulceration, and in addu-cent loop (more often in a caecum) at the phenomena of an obstruction (overdistension). Perforation in a free abdominal cavity conducts to deve-lopment of a fecal peritonitis. At per-foration phlegmons develop in a fat behind of an intestine and abscesses of a retroperitoneal fat.

Question
At what colon can-cer complication Schetkin-Blumberg sign more often is defined?

complications
Formation of fistulas at spreading at the nea-rest hollow organs (co-lo-small intestinal, co-lo-gastric, colo-vesical) carry to rare complica-tions

Cancer complication - fistula

Cancer complication - fistula

Cancer complication - fistula

complications
The intestinal bleeding happens, as a rule, insig-nificant. Sometimes it is shown in the form of an impurity of not changed blood in a feces. Is hid-den (occult) is more often.

Colon diseases

Cancer on a background a polyposis

Poliposis

Nonspecific colitises
1. Ulcerouse
2. Granulomatous (Crohn's disease)
3. Ischemic

«Drainpipe» sign

colitis

Cystous colitis

Extraintestinal displays
vessels
vasculitis
thromboembolism
liver
fatty steatosis
chronic active hepatitis
primary sclerosing cholangitis
joints
peripheral arthropathy
sacroiliac disease
spondylitis
eyes
episcleritis
uveitis
conjunctivitis
heart
plevroperikardit
myocarditis
kidneys
oxalate stones
renal tubular damage
skin
pyoderma gangrenosum
erythema nodosum

complications
Toxic megacolon
Perforation
Peritonitis
Intestinal obstruction
Bleedings
Abscesses
Fistulas
Infiltrates

Indications to operation at ulcerouse colitis
Intestinal bleeding.
1. The frequency of bowel movements 12 or more per day with a macroscopically severe admixture of blood against the background of the introduction of combined therapy with steroid hormones for 7 days;
2. The volume of the stool with the intense bloody 1000 ml per day or more;
3. The volume of blood loss, confirmed by scintigraphy, 150 ml per day or more.
Toxic dilatation of the colon
Perforation.

Pseudomembranous colitis

Polips
Hyperplastic
Tubular adenoma
Tubulary-villiferous adenoma
Villiferous adenoma

polips

poliposis

poliposis

Congenital diseases
1. Hirshsprung disease
2. Megacolon
3. Dolichocolon

Hirshsprung disease

Differential diagnostics
1. Myxedema
2. Medicinal influences (morphinum and so forth)
5. Depressions
6. Schizophrenia
7. Scleroderma
8. Chagas disease

diverticuls
Diverticul
Diverticulosis
Diverticulitis

diverticul

diverticulosis

diverticulosis

diverticuls

Multiple diverticuls

Diverticul - obturation

diverticulosis

Fecal stone in a diverticulum

diverticulitis

Clinical features
Acute diverticulitis is well nicknamed 'left-sided appendicitis'; an acute onset of central abdominal pain which shifts to the left iliac fossa accompanied by fever, vomiting and local tenderness and guarding. A vague mass may be felt in the left ileal fossa and also on rectal examination. Perforation into the general peritoneal cavity produces the signs of general peritonitis. A pericolic abscess is comparable to an appendix abscess but on the left side; a tender mass accompanied by a swinging fever and leucocytosis.

Clinical features
Chronic divertlcular disease exactly mimics the local clinical features of carcinoma of the colon; there may be diarrhoea alternating with constipation which progresses to a large bowel obstruction with vomiting, disten­sion, colicky abdominal pain and constipation: (note that small bowel obstruction from adhesion of a loop of small Intestine to the inflammatory mass is not uncommon). There may be episodes of pain in the left ileal fossa, passage of mucus or bright red blood per rectum or of melaena, or there may be anaemia due to chronic occult bleeding. Examination reveals tenderness in the left ileal fossa and there is often a thickened mass in the region of the sigmoid colon, which may also be felt per rectum.

Diverticulitis
This results from infection of one or more divertlcula. An inflamed diverticulum may.
1. Perforate:
a) into the general peritoneal cavity;
b) with formation of pericolic abscess;
c) into adjacent structures; bladder, small bowel and vagina;
2. Produce chronic infection with inflam-matory fibrosis resulting in strictures and obstructive symptoms — acute or chronic.
3. Haemorrhage, as a result of erosion of a vessel in the bowel wall. The bleeding varies from acute to a chronic occult loss.

Diverticulitis
The Hinchey classification - proposed by Hinchey et al. in 1978[1] classifies a colonic perforation due to diverticular disease. The classification is I-IV:
Hinchey I - localised abscess (paracolonic)
Hinchey II - pelvic abscess
Hinchey III - purulent peritonitis (the presence of pus in the abdominal cavity)
Hinchey IV - faeculent peritonitis.
The Hinchey classification is useful as it guides surgeons as to how conservative they can be in emergency surgery. Recent studies have shown with anything up to a Hinchey III, a laparoscopic washout is a safe procedure[2], avoiding the need for a laparotomy and stoma formation.

diverticulosis, bleeding,
subtotal colectomy

diverticulosis, bleeding,
subtotal colectomy