{"id":24210,"date":"2023-09-15T17:24:58","date_gmt":"2023-09-15T11:54:58","guid":{"rendered":"https:\/\/anatomystudyguide.com\/?p=24210"},"modified":"2023-10-21T20:39:26","modified_gmt":"2023-10-21T15:09:26","slug":"large-intestine-surgical-anatomy-notes","status":"publish","type":"post","link":"https:\/\/anatomystudyguide.com\/large-intestine-surgical-anatomy-notes\/","title":{"rendered":"Large Intestine Surgical Anatomy Notes"},"content":{"rendered":"<h2><span class=\"ez-toc-section\" id=\"Large_Intestine_Surgical_Anatomy\"><\/span>Large Intestine Surgical Anatomy<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<ol>\n<li>The large intestine extends from the ileocaecal valve to the anus. It has five segments: Right colon, left colon, transverse colon, sigmoid colon, rectum and anal canal<\/li>\n<li>The average length is about 135\u2013150 cm.<\/li>\n<li>Interestingly, alternating portions of the colon are mobile and fixed. The ascending colon and descending colon are fixed but the caecum, transverse colon and sigmoid colon are mobile. Mobile structures can undergo twisting (volvulus).<\/li>\n<li><strong>Layers of colon:<\/strong> Mucosa, submucosa, muscularis propria and serosa. Inner circular and outer longitudinal muscle layers constitute muscularis propria. In spite of 4 layers, the wall of the colon is thin.<\/li>\n<li>Hence it distends much more in obstruction.<\/li>\n<\/ol>\n<p><strong>Read And Learn More:<a href=\"https:\/\/anatomystudyguide.com\/gastrointestinal-surgery-notes\/\"> Gastrointestinal Surgery Notes<\/a><\/strong><\/p><div id=\"ez-toc-container\" class=\"ez-toc-v2_0_57 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<p class=\"ez-toc-title\">Table of Contents<\/p>\n<label for=\"ez-toc-cssicon-toggle-item-665a8644aff79\" class=\"ez-toc-cssicon-toggle-label\"><span class=\"ez-toc-cssicon\"><span style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/label><input type=\"checkbox\"  id=\"ez-toc-cssicon-toggle-item-665a8644aff79\"  aria-label=\"Toggle\" \/><nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='insert-page-1 insert-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/anatomystudyguide.com\/large-intestine-surgical-anatomy-notes\/#Large_Intestine_Surgical_Anatomy\" title=\"Large Intestine Surgical Anatomy\">Large Intestine Surgical Anatomy<\/a><\/li><li class='insert-page-1 insert-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/anatomystudyguide.com\/large-intestine-surgical-anatomy-notes\/#Tumours_Of_The_Large_Intestine\" title=\"Tumours Of The Large Intestine\">Tumours Of The Large Intestine<\/a><\/li><li class='insert-page-1 insert-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/anatomystudyguide.com\/large-intestine-surgical-anatomy-notes\/#Adenomatous_Polyp\" title=\"Adenomatous Polyp\">Adenomatous Polyp<\/a><\/li><li class='insert-page-1 insert-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/anatomystudyguide.com\/large-intestine-surgical-anatomy-notes\/#Hamartomatous_Polyp_Juvenile_Polyp\" title=\"Hamartomatous Polyp (Juvenile Polyp)\">Hamartomatous Polyp (Juvenile Polyp)<\/a><\/li><li class='insert-page-1 insert-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/anatomystudyguide.com\/large-intestine-surgical-anatomy-notes\/#Familial_Polyposis_Coli_Fpc_Or_Familial_Adenomatous_Polyposis_Fap\" title=\"Familial Polyposis Coli (Fpc) Or Familial Adenomatous Polyposis (Fap)\">Familial Polyposis Coli (Fpc) Or Familial Adenomatous Polyposis (Fap)<\/a><\/li><li class='insert-page-1 insert-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/anatomystudyguide.com\/large-intestine-surgical-anatomy-notes\/#Metaplastic_Polyp\" title=\"Metaplastic Polyp\">Metaplastic Polyp<\/a><\/li><li class='insert-page-1 insert-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/anatomystudyguide.com\/large-intestine-surgical-anatomy-notes\/#Hereditary_Nonpolyposis_Colorectal_Cancer_Hnpcc\" title=\"Hereditary Nonpolyposis Colorectal Cancer (Hnpcc)\">Hereditary Nonpolyposis Colorectal Cancer (Hnpcc)<\/a><\/li><li class='insert-page-1 insert-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/anatomystudyguide.com\/large-intestine-surgical-anatomy-notes\/#Examination_Of_Colon\" title=\"Examination Of Colon\">Examination Of Colon<\/a><\/li><li class='insert-page-1 insert-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/anatomystudyguide.com\/large-intestine-surgical-anatomy-notes\/#Carcinoma_Colon\" title=\"Carcinoma Colon\">Carcinoma Colon<\/a><\/li><li class='insert-page-1 insert-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/anatomystudyguide.com\/large-intestine-surgical-anatomy-notes\/#Synchronous_Carcinoma\" title=\"Synchronous Carcinoma\">Synchronous Carcinoma<\/a><\/li><li class='insert-page-1 insert-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/anatomystudyguide.com\/large-intestine-surgical-anatomy-notes\/#Enhanced_Recovery_Programme_ERAS\" title=\"Enhanced Recovery Programme (ERAS)\">Enhanced Recovery Programme (ERAS)<\/a><\/li><li class='insert-page-1 insert-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/anatomystudyguide.com\/large-intestine-surgical-anatomy-notes\/#Postoperative_Chemotherapy\" title=\"Postoperative Chemotherapy\">Postoperative Chemotherapy<\/a><\/li><li class='insert-page-1 insert-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/anatomystudyguide.com\/large-intestine-surgical-anatomy-notes\/#Sugeries_In_A_Case_Of_Carcinoma_Colon\" title=\"Sugeries In A Case Of Carcinoma Colon\">Sugeries In A Case Of Carcinoma Colon<\/a><\/li><li class='insert-page-1 insert-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-14\" href=\"https:\/\/anatomystudyguide.com\/large-intestine-surgical-anatomy-notes\/#Postoperative_Radiotherapy\" title=\"Postoperative Radiotherapy\">Postoperative Radiotherapy<\/a><\/li><li class='insert-page-1 insert-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-15\" href=\"https:\/\/anatomystudyguide.com\/large-intestine-surgical-anatomy-notes\/#Colonic_Structure\" title=\"Colonic Structure\">Colonic Structure<\/a><\/li><\/ul><\/nav><\/div>\n\n<p><strong>Caecum<\/strong><\/p>\n<ul>\n<li>7.5 cm in both length and breadth<\/li>\n<li>Blind pouch<\/li>\n<li>Completely covered by peritoneum except posterior surface<\/li>\n<li>Mobile<\/li>\n<\/ul>\n<p><strong>Caecum Diseases:\u00a0<\/strong><\/p>\n<ul>\n<li>Carcinoma<\/li>\n<li>Tuberculosis<\/li>\n<li>Amoebic typhlitis<\/li>\n<li>Intussusception<\/li>\n<li>Volvulus\u2014rare<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24235\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Anatomy-Of-The-Colon-And-Parts-1.png\" alt=\"Large Intestine Anatomy Of The Colon And Parts\" width=\"374\" height=\"477\" data-wp-editing=\"1\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Anatomy-Of-The-Colon-And-Parts-1.png 374w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Anatomy-Of-The-Colon-And-Parts-1-235x300.png 235w\" sizes=\"(max-width: 374px) 100vw, 374px\" \/><\/p>\n<p><strong>Ascending Colon (15 cm Long)<\/strong><\/p>\n<ul>\n<li>Caecum continues as ascending colon.<\/li>\n<li>Covered by peritoneum in front and on both sides.<\/li>\n<li>In 25% of patients, it has a mesentery.<\/li>\n<li>The right paracolic gutter is deep on the lateral aspect of ascending colon\u2014space for paracolic abscess in cases of perforation peritonitis.<\/li>\n<\/ul>\n<p><strong>Transverse Colon (50 cm Long)<\/strong><\/p>\n<ul>\n<li>The most mobile part of large intestine.<\/li>\n<li>It is suspended by transverse mesocolon, loops down and is adherent to the posterior wall of the omental bursa.<\/li>\n<\/ul>\n<p><strong>Transverse Colon Diseases:<\/strong><\/p>\n<ul>\n<li>Cancer<\/li>\n<li>Ulcerative colitis<\/li>\n<\/ul>\n<p><strong>Descending Colon (25 cm Long)<\/strong><\/p>\n<ul>\n<li>Continues as sigmoid colon<\/li>\n<li>Retroperitoneal (like ascending colon)<\/li>\n<li>Also has a paracolic gutter<\/li>\n<\/ul>\n<p><strong>Sigmoid (40 cm Long)<\/strong><\/p>\n<ul>\n<li>S-shaped<\/li>\n<li>Ends as a rectosigmoid junction where taenia coli ends.<\/li>\n<\/ul>\n<p><strong>Sigmoid<\/strong> <strong>Diseases:<\/strong><\/p>\n<ul>\n<li>Volvulus<\/li>\n<li>Diverticulosis<\/li>\n<li>Cancer<\/li>\n<\/ul>\n<p><strong>Right Colon: <\/strong>The big\u00a0and hepatic flexure is broad.<\/p>\n<p><strong>Left Colon<\/strong><\/p>\n<ul>\n<li>Small and splenic flexure is acute. Hence, ischaemic colitis commonly affects splenic flexure<\/li>\n<li>Splenic flexure is deeply situated. Therefore, malignancy in this area can be easily missed.<\/li>\n<\/ul>\n<p><strong>Comparison between Right and Left colon:<\/strong><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24252\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Comparison-Between-And-Right-Colon-And-Left-Colon.png\" alt=\"Large Intestine Comparison Between And Right Colon And Left Colon\" width=\"857\" height=\"283\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Comparison-Between-And-Right-Colon-And-Left-Colon.png 857w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Comparison-Between-And-Right-Colon-And-Left-Colon-300x99.png 300w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Comparison-Between-And-Right-Colon-And-Left-Colon-768x254.png 768w\" sizes=\"(max-width: 857px) 100vw, 857px\" \/><\/p>\n<p><strong>Muscle Coat<\/strong><\/p>\n<ul>\n<li>Outer longitudinal muscle is arranged in the form of three strips called taenia coli.<\/li>\n<li>All three join at the rectosigmoid junction and form a complete longitudinal layer of the rectum. These three taenia coli converge at the base of the appendix.<\/li>\n<li>This is an important method to localise the appendix. Inner circular muscle coalesces distally to form an internal anal sphincter. No taenia over the rectum.<\/li>\n<\/ul>\n<p><strong>Recognise large intestine by:<\/strong><\/p>\n<ul>\n<li>Taenia coli<\/li>\n<li>Omental appendices\u2014appendicular epiploic ae<\/li>\n<li>Haustrations<\/li>\n<li>Large diameter (calibre)<\/li>\n<\/ul>\n<p><strong>Names of three Taenia coli:\u00a0<\/strong><\/p>\n<ol>\n<li><strong>Mesocolic:<\/strong> Transverse colon and sigmoid colon are attached by this.<\/li>\n<li><strong>Omental:<\/strong> To which omental appendices attach.<\/li>\n<li><strong>Libera (free):<\/strong> Nothing is attached.<\/li>\n<\/ol>\n<p><strong>Colorectal Arterial Supply<\/strong><\/p>\n<p><strong>1. Superior mesenteric artery:<\/strong><\/p>\n<p>A branch of the abdominal aorta arises at the level of the first lumbar vertebra (L1). It supplies the entire small bowel and the right colon up to the proximal 2\/3rds of the transverse colon.<\/p>\n<p><strong>Branches of the superior mesenteric artery (SMA) supplying the colon are:<\/strong><\/p>\n<ul>\n<li><strong>Middle colic artery:<\/strong>\u00a0 The middle colic artery supplies ascending colon, hepatic flexure and transverse colon. It divides into right and left branches.<\/li>\n<li>The right colic artery supplies the right colon.<\/li>\n<li>The ileocolic artery supplies the terminal ileum and ascending colon. It divides into anterior and posterior caecal branches and supplies the caecum and appendix through the appendicular artery.<\/li>\n<\/ul>\n<p><strong>Comparison Between Right And Left Colon:<\/strong><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24393\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Comparison-Between-And-Right-Colon-And-Left-Colon-1.png\" alt=\"Large Intestine Comparison Between And Right Colon And Left Colon\" width=\"857\" height=\"283\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Comparison-Between-And-Right-Colon-And-Left-Colon-1.png 857w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Comparison-Between-And-Right-Colon-And-Left-Colon-1-300x99.png 300w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Comparison-Between-And-Right-Colon-And-Left-Colon-1-768x254.png 768w\" sizes=\"(max-width: 857px) 100vw, 857px\" \/><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24264\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Blood-Supply-Of-The-Right-Colon.png\" alt=\"Large Intestine Blood Supply Of The Right Colon\" width=\"497\" height=\"445\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Blood-Supply-Of-The-Right-Colon.png 497w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Blood-Supply-Of-The-Right-Colon-300x269.png 300w\" sizes=\"(max-width: 497px) 100vw, 497px\" \/><\/p>\n<p><strong>2. The inferior mesenteric artery (IMA):<\/strong> A branch of the abdominal aorta arising at the level of L3, supplies the left colon up to the mucocutaneous junction at the lower end of the anal canal (Hilton\u2019s line).<\/p>\n<p><strong> Its branches are:<\/strong><\/p>\n<ol>\n<li><strong>Left colic artery:<\/strong> Left colic artery which anastomoses with branches of the middle colic artery. It divides into upper and lower branches supplying the descending colon.<\/li>\n<li><strong>Three sigmoidal branches supply the sigmoid colon:<\/strong> The narrow point of blood supply between the first sigmoidal artery and left coelic artery is called Sudeck\u2019s point.<\/li>\n<li><strong>\u00a0Superior haemorrhoidal artery (rectal):\u00a0<\/strong>\n<ul>\n<li>The anastomotic branches form the marginal artery of Drummond, which is relatively narrow in the region of splenic flexure (another reason for the development of ischaemia).<\/li>\n<li>That narrow point is called Griffith\u2019s point.<\/li>\n<li>The Arc of Riolan is the anastomotic arcade formed between branches of IMA and SMA.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24265\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Arterial-Supply-Of-Left-Colon.png\" alt=\"Large Intestine Arterial Supply Of Left Colon\" width=\"510\" height=\"459\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Arterial-Supply-Of-Left-Colon.png 510w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Arterial-Supply-Of-Left-Colon-300x270.png 300w\" sizes=\"(max-width: 510px) 100vw, 510px\" \/><\/p>\n<p><strong>Colorectal Venous Supply<\/strong><\/p>\n<ul>\n<li>Follows the corresponding artery and empties into superior and inferior mesenteric veins, ultimately draining into the portal vein.<\/li>\n<li>Thus, if the colorectal area gets infected secondary to inflammatory conditions or after a surgical procedure, the infection can easily spread to the portal vein and result in portal pyaemia.<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24266\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Venous-Drainage.png\" alt=\"Large Intestine Venous Drainage\" width=\"742\" height=\"478\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Venous-Drainage.png 742w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Venous-Drainage-300x193.png 300w\" sizes=\"(max-width: 742px) 100vw, 742px\" \/><\/p>\n<p><strong>Lymphatic Drainage<\/strong><\/p>\n<ol>\n<li><strong>N1:<\/strong> Epicolic and paracolic nodes are the first to get involved.<\/li>\n<li><strong>N2:<\/strong> Nodes at the origin of ileocolic and middle colic arteries\u2014intermediate nodes.<\/li>\n<li>N3: Nodes at the origin of superior and inferior mesenteric arteries. They are involved in approximately 50% of the patients with carcinoma colon at presentation to the hospital. These are called principal nodes.<\/li>\n<\/ol>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24267\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Lymphatic-Drainage.png\" alt=\"Large Intestine Lymphatic Drainage\" width=\"599\" height=\"480\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Lymphatic-Drainage.png 599w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Lymphatic-Drainage-300x240.png 300w\" sizes=\"(max-width: 599px) 100vw, 599px\" \/><\/p>\n<p><strong>Colorectal Nerve Supply<\/strong><\/p>\n<ul>\n<li>Sympathetic (inhibitory) arise from T10\u2013T12 and L1\u2013L<\/li>\n<li>Parasympathetic (stimulation).\n<ul>\n<li>The vagus nerve supplies the right and transverse colon.<\/li>\n<li>Sacral nerves (S2\u2013S4 which form nervi erigentes) supply the distal colon, i.e. splenic flexure onwards.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Colorectal Significance:\u00a0<\/strong><\/p>\n<ul>\n<li>Colonic pseudo-obstruction starts from splenic flexure.<\/li>\n<li>The transition zone of vagal supply to sacral nerve supply.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Tumours_Of_The_Large_Intestine\"><\/span>Tumours Of The Large Intestine<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Benign tumours are usually referred to as polyps, which means elevated from the surface. Adenomatous polyps have got malignant potential. A few criteria have been incorporated into a system when malignancy develops in the polyp.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24268\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Polyp.png\" alt=\"Large Intestine Polyp\" width=\"579\" height=\"454\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Polyp.png 579w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Polyp-300x235.png 300w\" sizes=\"(max-width: 579px) 100vw, 579px\" \/><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24269\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Pedunculated-Adenoma.png\" alt=\"Large Intestine Pedunculated Adenoma\" width=\"520\" height=\"478\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Pedunculated-Adenoma.png 520w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Pedunculated-Adenoma-300x276.png 300w\" sizes=\"(max-width: 520px) 100vw, 520px\" \/><\/p>\n<ul>\n<li>It takes into consideration of level of invasion.<\/li>\n<li><strong>Level 1:<\/strong> In this, carcinoma is limited to the top of the polyp. From the mucosa, it is invading through muscularis mucosa into the submucosa.<\/li>\n<li><strong>Level 2:<\/strong> Carcinoma at the junction of head and stalk.<\/li>\n<li><strong>Level 3:<\/strong> Carcinoma confined to anywhere in the stalk.<\/li>\n<li><strong>Level 4:<\/strong> Infiltration into submucosa.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Adenomatous_Polyp\"><\/span>Adenomatous Polyp<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<ul>\n<li>It may be a villous adenoma which is a flat lesion or a tubular adenoma having a pedicle. Tubular is more common.<\/li>\n<li>They give rise to bleeding, mucus diarrhoea and hypokalaemia.<\/li>\n<li>They can be single or multiple.<\/li>\n<li>They are dysplastic.<\/li>\n<li>They are premalignant and the risk of malignancy is greater with an increase in the size of the adenoma.<\/li>\n<li>They can be removed with the colonoscope\u2014 polypectomy.<\/li>\n<li>The malignant potential of villous adenoma is more than tubular adenoma.<\/li>\n<li>Adenoma less than 1 cm\u2014the risk of malignancy is 1%; 1\u20132 cm is 10%; &gt;2 cm is 30%.<\/li>\n<li>Most of the neoplastic polyps occur in elderly patients(&gt;50 years).<\/li>\n<li>Most of them are pedunculated.<\/li>\n<li>Most pedunculated polyps are removed by colonoscopic snaring.<\/li>\n<li>Adenomas larger than 5 mm in diameter carry a risk of malignant potential.<\/li>\n<li>The more the polyps, the more chances of synchronous carcinoma.<\/li>\n<li>Flat adenomas also carry malignant potential.<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24272\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Carcinoma-In-Polyp.png\" alt=\"Large Intestine Carcinoma In Polyp\" width=\"474\" height=\"420\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Carcinoma-In-Polyp.png 474w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Carcinoma-In-Polyp-300x266.png 300w\" sizes=\"(max-width: 474px) 100vw, 474px\" \/><\/p>\n<p><strong>Symptoms and signs of polyps:<\/strong> Bleeding per rectum is the most common symptom. Fresh bleeding is seen in rectal polyps. Typically, it is painless. It is intermittent. If it is associated with the change of bowel habits it is probably a malignant change. These changes include mucus discharge, tenesmus, and sometimes constipation. In children, polyps may project outside the anus. In such cases, it has to be distinguished from a prolapsed rectum.<\/p>\n<p><strong>Adenomatous Polyp Treatment:\u00a0<\/strong><\/p>\n<ul>\n<li>Colonoscopy and polypectomy is the standard treatment.<\/li>\n<li>If the specimen shows invasive carcinoma, radical surgery needs to be done.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Hamartomatous_Polyp_Juvenile_Polyp\"><\/span>Hamartomatous Polyp (Juvenile Polyp)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<ul>\n<li>This can occur in the colon as in Peutz-Jeghers syndrome. The risk of malignancy is very limited.<\/li>\n<li>Symptomatic polyps need to be treated.<\/li>\n<li>Juvenile polyps are usually single and occur in children. They give rise to bleeding and are easily resected. They do not have malignant potential.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Familial_Polyposis_Coli_Fpc_Or_Familial_Adenomatous_Polyposis_Fap\"><\/span>Familial Polyposis Coli (Fpc) Or Familial Adenomatous Polyposis (Fap)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<ul>\n<li>FAP is a genetic disorder inherited as a Mendelian dominant. The gene APC (adenomatous polyposis coli) is located on the short arm of chromosome 5. Prevalence: 1 in 10,000. It is clinically defined by the presence of more than 100 colorectal adenomas.<\/li>\n<li>It is transmitted from both sexes. The incidence is same in either sex.<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24273\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Thousands-Of-Polyp.png\" alt=\"Large Intestine Thousands Of Polyp\" width=\"511\" height=\"437\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Thousands-Of-Polyp.png 511w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Thousands-Of-Polyp-300x257.png 300w\" sizes=\"(max-width: 511px) 100vw, 511px\" \/><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24274\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Close-Up-View-Of-The-Polyps.png\" alt=\"Large Intestine Close Up View Of The Polyps\" width=\"692\" height=\"424\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Close-Up-View-Of-The-Polyps.png 692w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Close-Up-View-Of-The-Polyps-300x184.png 300w\" sizes=\"(max-width: 692px) 100vw, 692px\" \/><\/p>\n<ul>\n<li>When it is associated with desmoid tumour, craniofacial osteomas, epidermoid cysts, and congenital hypertrophy of retinal pigment epithelium, it is described as Gardner\u2019s syndrome.<\/li>\n<li>When familial polyposis coli is associated with central nervous system tumour and glioblastoma, it is called Turcot\u2019s syndrome.<\/li>\n<li>50% of them have benign gastric polyps and 90% of them have duodenal polyps.<\/li>\n<\/ul>\n<p><strong>\u00a0FAP <\/strong><strong>Clinical Features:\u00a0<\/strong><\/p>\n<ul>\n<li>Runs in families; other members of the family are affected.<\/li>\n<li>Manifests at the age of 20 in the form of blood and mucus in the stool, loose stools, etc. It produces crampy lower abdominal pain.<\/li>\n<li>Anaemia, weight loss and protein malnutrition occur slowly.<\/li>\n<li>The mean age of development of carcinoma is 29 years.<\/li>\n<\/ul>\n<p><strong>FAP Complications: <\/strong>Malignancy (100% risk)<\/p>\n<p><strong>Family Polyposis Coli:<\/strong><\/p>\n<ul>\n<li>Polyps are more than 100 (colorectal adenomas).<\/li>\n<li>Other mesodermal tumours\u2014desmoid tumours, osteoma, and epidermoid cysts can be present (Gardner\u2019s syndrome).<\/li>\n<li>Large bowel is predominantly involved.<\/li>\n<li>Year of development of carcinoma\u2014mean age 39 years.<\/li>\n<li>Polyposis gene\u2014autosomal dominant APC gene.<\/li>\n<li>Other syndrome\u2014Turcot<\/li>\n<li>Sigmoidoscopy from the age of 15 at intervals is the investigation of choice.<\/li>\n<li>I leoanal anastomosis with pouch\u2014restorative proctocolectomy\u2014advisable above age of 30.<\/li>\n<li>Surgery is the only means of preventing colonic cancer.<\/li>\n<li>Remember as<strong> POLYPOSI<\/strong><\/li>\n<\/ul>\n<p><strong>FAP Treatment:\u00a0<\/strong><\/p>\n<ul>\n<li><strong>NSAID:<\/strong> Sulindac 300 mg, twice a day and aspirin 325 mg once a day have been found to decrease the size of polyps.<\/li>\n<li>Patients with FAP who are above the age of 30 have high chances of having a carcinoma in the colon. Hence, even when there is no malignancy, surgery is advisable.<\/li>\n<\/ul>\n<p><strong>Types of Surgery:<\/strong><\/p>\n<ul>\n<li>Many patients do not like ileostomy. Hence, a subtotal colectomy with ileorectal anastomosis can be done.<\/li>\n<li>This is done provided that the rectum is examined frequently and endoscopic snaring of the polyps is done regularly, especially in a young patient.<\/li>\n<li>Restorative proctocolectomy with ileoanal anastomosis by using a pouch is another alternative.<\/li>\n<li>However, it is a major surgical procedure and should be undertaken only by an experienced surgeon.<\/li>\n<\/ul>\n<p><strong>Screening: <\/strong>Starts from the age of 10\u201312 years, repeat every 1\u20132 years.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Metaplastic_Polyp\"><\/span>Metaplastic Polyp<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Also called hyperplastic nodules. They are of viral aetiology. They do not have malignant potential.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24275\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Familial-Adenomatous-Polyposis-With-Two-Malignancies.png\" alt=\"Large Intestine Familial Adenomatous Polyposis With Two Malignancies\" width=\"529\" height=\"442\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Familial-Adenomatous-Polyposis-With-Two-Malignancies.png 529w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Familial-Adenomatous-Polyposis-With-Two-Malignancies-300x251.png 300w\" sizes=\"(max-width: 529px) 100vw, 529px\" \/><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Hereditary_Nonpolyposis_Colorectal_Cancer_Hnpcc\"><\/span>Hereditary Nonpolyposis Colorectal Cancer (Hnpcc)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<ul>\n<li>Autosomal dominant, no polyps<\/li>\n<li>Lynch\u2019s syndrome 1: Site-specific colorectal cancer.<\/li>\n<li>Lynch\u2019s syndrome 2: Cancer family syndrome\u2014they have extracolonic cancers such as endometrial cancer, ovarian cancer, transitional cell cancer, etc.<\/li>\n<li>The lifetime risk of developing colorectal cancer is 80%.<\/li>\n<li>Synchronous carcinoma means more than one cancer at the time of diagnosis. Metachronous carcinoma which means the appearance of a second carcinoma after 6 months can occur here.<\/li>\n<\/ul>\n<p><strong>Diagnostic Criteria (Amsterdam Criteria II):<\/strong><\/p>\n<ul>\n<li>At least 3 members in a family should have colorectal cancer\u2014two of whom are first-degree relatives.<\/li>\n<li>At least two consecutive generations.<\/li>\n<li>At least one relative should have had colorectal cancer by less than 50 years of age.<\/li>\n<li>Exclusion of FAP.<\/li>\n<\/ul>\n<p><strong>Screening: <\/strong>Increased incidence of proximal colonic cancer.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Examination_Of_Colon\"><\/span>Examination Of Colon<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><strong>Anoproctoscopy:<\/strong> One can examine up to 10\u201312 cm of the anal canal and rectum. Rubber band ligation (for piles) and polypectomy can be done with this instrument.<\/p>\n<p><strong>Flexible sigmoidoscopy:<\/strong><\/p>\n<p>The scope measures about 60 cm in length. One can easily reach up to splenic flexure.<\/p>\n<ul>\n<li>A bowel wash or an enema is given before the procedure.<\/li>\n<li>No sedation is required.<\/li>\n<\/ul>\n<p><strong>Fibreoptic colonoscopy:<\/strong> Fibreoptic colonoscopy can assess the entire colon. It is 100\u2013160 cm in length.<\/p>\n<ul>\n<li>Usually, there will be multiple polyps varying from a few millimetres to centimetres.<\/li>\n<li>A biopsy has to be taken. Polyps are visible after 15 years and certainly by the age of 30 years.<\/li>\n<li>It is the investigation of choice in most of the large intestinal lesions.<\/li>\n<li>It permits examination of the entire colon and terminal ileum.<\/li>\n<li>Colon is prepared by polyethene glycol given orally.<\/li>\n<li>The risk of perforation of the colon is less than 0.1%.<\/li>\n<\/ul>\n<p><strong>Colon Indications:<\/strong><\/p>\n<ul>\n<li><strong>Diagnostic:\u00a0 <\/strong>Lower gastrointestinal bleeding\n<ul>\n<li>Inflammatory bowel diseases<\/li>\n<li>Abnormal finding in barium enema<\/li>\n<li>Family history of colorectal cancers<\/li>\n<li>Biopsy of caecum\/ileum in suspected cases of cancer<\/li>\n<li>Ileocaecal tuberculosis\u2014to take a biopsy<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24276\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Rigid-Sigmoido-Scope.png\" alt=\"Large Intestine Rigid Sigmoido Scope\" width=\"348\" height=\"486\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Rigid-Sigmoido-Scope.png 348w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Rigid-Sigmoido-Scope-215x300.png 215w\" sizes=\"(max-width: 348px) 100vw, 348px\" \/><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24277\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Flexible-Sigmoidoscope.png\" alt=\"Large Intestine Flexible Sigmoidoscope\" width=\"346\" height=\"503\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Flexible-Sigmoidoscope.png 346w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Flexible-Sigmoidoscope-206x300.png 206w\" sizes=\"(max-width: 346px) 100vw, 346px\" \/><\/p>\n<ul>\n<li><strong>Therapeutic:<\/strong>\n<ul>\n<li>Control of bleeding\u2014coagulation or injection sclerotherapy<\/li>\n<li>Snaring of polyps<\/li>\n<li>Removal of foreign body<\/li>\n<li>Detorsion of volvulus<\/li>\n<li>Decompression of pseudo-obstruction<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Carcinoma_Colon\"><\/span>Carcinoma Colon<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><strong>Carcinoma Colon Introduction:<\/strong><\/p>\n<p>It is the second most common cancer and cancer-related death cases in the Western world next only to lung cancer. The incidence increases with age. Multiple synchronous lesions (more than 1 malignancy at the time of diagnosis) are found in about 5% of the patients.<\/p>\n<ul>\n<li>Colon is also one of the sites of metachronous cancer (new malignancy appearing after 6 months of curative surgery).<\/li>\n<li>More than 95% are adenocarcinoma and surgery remains the most effective treatment. Survival has improved because of early diagnosis and multimodality of the treatment.<\/li>\n<li>Over a period of years, the understanding of the development of carcinoma has changed and more and more molecular biology of colonic cancer is being discussed.<\/li>\n<li>The Fearon-Vogelstein adenoma\u2013carcinoma multistep model of colorectal neoplasia represents one of the best-known models of carcinogenesis.<\/li>\n<\/ul>\n<p><strong>Carcinoma Colon Terminology:<\/strong><\/p>\n<ul>\n<li>Before we start the discussion on carcinoma colon, we shall study a few terminologies used in carcinoma colon.<\/li>\n<li>They are synchronous carcinoma, metachronous carcinoma, and familial colorectal carcinoma.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Synchronous_Carcinoma\"><\/span>Synchronous Carcinoma<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><strong>Moertel\u2019s definition:<\/strong><\/p>\n<ul>\n<li>Synchronous cancers as those occurring within 6 months of the first primary cancer, or two or more histologically distinct simultaneously detected malignancies or more than one malignancy at the time of initial diagnosis.<\/li>\n<li>This will happen especially in cases of the colon and upper aerodigestive tract wherein the stimulus or aetiological factor for malignancy affects different parts of the organ.<\/li>\n<li>The colon, head and neck, and oesophagus are the sites of synchronous carcinomas.<\/li>\n<li>In cases of carcinoma colon with specific aetiological factors such as familial polyposis coli, ulcerative colitis, and hereditary non-polyposis cancer, often carcinoma is synchronous.<\/li>\n<li>Thus, it is important to do a complete colonoscopy when a patient comes with colonic carcinoma because he\/she may be having another synchronous carcinoma elsewhere.<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24283\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Fearon-Vogelstein-Model.png\" alt=\"Large Intestine Fearon Vogelstein Model\" width=\"527\" height=\"499\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Fearon-Vogelstein-Model.png 527w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Fearon-Vogelstein-Model-300x284.png 300w\" sizes=\"(max-width: 527px) 100vw, 527px\" \/><\/p>\n<p><strong>Large Intestine clinical notes:\u00a0<\/strong><\/p>\n<ul>\n<li>A 68-year-old lady was admitted with a large bowel obstruction. A plain X-ray abdomen showed intestinal obstruction.<\/li>\n<li>An exploratory laparotomy was done. A 3 cm constricting growth was identified at the rectosigmoid junction and high anterior resection and anastomosis were done. On the 4th postoperative day, the patient was allowed a liquid diet.<\/li>\n<li>Distension increased. For another 3 days, distension went on increasing. A plain X-ray abdomen revealed obstruction with more gas than before. The patient was having colicky abdominal pain.<\/li>\n<li>An exploratory laparotomy was done. Findings at 2nd laparotomy\u2014 anastomosis was intact. The transverse colon was hugely dilated. Careful palpation of the splenic flexure revealed one more growth. A resection and anastomosis were done again.<\/li>\n<li>The patient was discharged after 10 days. The first surgeon agreed that after finding the rectosigmoid growth, he did not look for any other lesions (mistake). This was obviously a case of synchronous carcinoma.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Enhanced_Recovery_Programme_ERAS\"><\/span>Enhanced Recovery Programme (ERAS)<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Enhanced Recovery After Surgery (ERAS)<\/p>\n<ul>\n<li>It is also described as ERP (enhanced recovery programme), also called fast track surgery.<\/li>\n<li>Traditionally hospital stay following colorectal surgery is about 10\u201314 days. Now, with a few important steps taken in the pre-, peri- and postoperative periods, it is possible to decrease hospital stay to 2\u20135 days.<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24351\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Surgery.png\" alt=\"Large Intestine Surgery\" width=\"660\" height=\"367\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Surgery.png 660w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Surgery-300x167.png 300w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Surgery-630x350.png 630w\" sizes=\"(max-width: 660px) 100vw, 660px\" \/><\/p>\n<p><strong>Preoperative Steps:<\/strong><\/p>\n<ul>\n<li>Metabolic response to injury\/surgery produces increasing metabolic demands and nitrogen consumption. A few days into the postoperative period, there will be a catabolic phase resulting in loss of muscle mass.<\/li>\n<li>Carbohydrate loading done a few hours before surgery decreases postoperative complications by decreasing postoperative insulin resistance and negative nitrogen balance.<\/li>\n<li>Only patients with anterior resection need to have bowel preparation. For all other colonic surgery, a single enema is more than enough.<\/li>\n<\/ul>\n<p><strong>Perioperative Steps:<\/strong><\/p>\n<p>Laparoscopic surgery gives the best results in the form of less pain, fewer wounds, less manipulation, less handling of the bowel, no exposure to the environment. (Thus recovery is fast.) Anaesthetic requirements are less including analgesia.<\/p>\n<ul>\n<li>Avoid long-acting narcotic analgesics.<\/li>\n<li>Avoid pre-medication.<\/li>\n<li>Mid-thoracic epidural block can be offered.<\/li>\n<li>Avoid tubes and catheters such as nasogastric tube (Ryle\u2019s tube) unless there is distension, postoperative drains (unless suspicious of doubtful anastomosis).<\/li>\n<li>Avoid central line and arterial lines.<\/li>\n<li>Preoperative-fluid restrictions\u2014do not overload with water and sodium. Fluids should be less than 2 litres.<\/li>\n<li>Meticulous technique decreases the time taken for surgery, decreases in number of ports and small incisions for retrieval of specimen\u2014all matters in ERAS.<\/li>\n<\/ul>\n<p><strong>Postoperative Steps:<\/strong><\/p>\n<ul>\n<li>Analgesics should be planned well\u2014epidural blocks.<\/li>\n<li>Early mobilisation.<\/li>\n<li>Look for ileus\/complications. If present, one should be ready to manage.<\/li>\n<li>Early feeding\u2014carbohydrate liquids.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Postoperative_Chemotherapy\"><\/span>Postoperative Chemotherapy<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<ul>\n<li>pT1-2N0M0 do not require any adjuvant treatment, such patients can be kept on follow-up with routine 3 monthly <strong>CEA<\/strong> and annual <strong>CECT t<\/strong>horax\/abdomen\/ pelvis.<\/li>\n<li>pT3N0M0 or node-positive disease requires adjuvant treatment in the form of concurrent chemoradiotherapy and chemotherapy. 2 cycles of <strong>FOLFOX<\/strong> (5- FU + Leucovorin + Oxaliplatin) \u2192 Concurrent 5-FU\/ Leucovorin and radiation \u2192 2 more cycles of<strong> FOLFOX<\/strong>. Oral Capecitabine can be used in place of IV 5-FU.<\/li>\n<li>It is preferable to add Oxaliplatin in the chemotherapy regimen if nodes are positive for metastatic disease. In older population (&gt;65\u201370 years), it might be of less benefit.<\/li>\n<li>Oxaloplatins have been shown to downsize liver metastasis. A chief complication of Oxaliplatin is peripheral neuropathy.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Sugeries_In_A_Case_Of_Carcinoma_Colon\"><\/span>Sugeries In A Case Of Carcinoma Colon<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24352\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Right-Hemicolectomy.png\" alt=\"Large Intestine Right Hemicolectomy\" width=\"613\" height=\"406\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Right-Hemicolectomy.png 613w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Right-Hemicolectomy-300x199.png 300w\" sizes=\"(max-width: 613px) 100vw, 613px\" \/><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24353\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Palliative-Ileptransverse-Anastomosis.png\" alt=\"Large Intestine Palliative Ileptransverse Anastomosis\" width=\"579\" height=\"384\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Palliative-Ileptransverse-Anastomosis.png 579w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Palliative-Ileptransverse-Anastomosis-300x199.png 300w\" sizes=\"(max-width: 579px) 100vw, 579px\" \/><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24354\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Extended-Right-For-Growth-Hemicolectomy.png\" alt=\"Large Intestine Extended Right For Growth Hemicolectomy\" width=\"528\" height=\"369\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Extended-Right-For-Growth-Hemicolectomy.png 528w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Extended-Right-For-Growth-Hemicolectomy-300x210.png 300w\" sizes=\"(max-width: 528px) 100vw, 528px\" \/><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24355\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Transverse-Colectomy-Followed-By-Colocolic.png\" alt=\"Large Intestine Transverse Colectomy Followed By Colocolic\" width=\"628\" height=\"423\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Transverse-Colectomy-Followed-By-Colocolic.png 628w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Transverse-Colectomy-Followed-By-Colocolic-300x202.png 300w\" sizes=\"(max-width: 628px) 100vw, 628px\" \/><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24356\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Left-Hemicolectomy-For-Growth-In-The-Splenic.png\" alt=\"Large Intestine Left Hemicolectomy For Growth In The Splenic\" width=\"584\" height=\"415\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Left-Hemicolectomy-For-Growth-In-The-Splenic.png 584w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Left-Hemicolectomy-For-Growth-In-The-Splenic-300x213.png 300w\" sizes=\"(max-width: 584px) 100vw, 584px\" \/><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24358\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Resection-Of-Rectosigmoid.png\" alt=\"Large Intestine Resection Of Rectosigmoid\" width=\"603\" height=\"453\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Resection-Of-Rectosigmoid.png 603w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Resection-Of-Rectosigmoid-300x225.png 300w\" sizes=\"(max-width: 603px) 100vw, 603px\" \/><\/p>\n<p><strong>Summary of the resections for carcinoma colon:<\/strong><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-24359\" src=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Summary-Of-The-Resections-For-Carcinoma-Colon.png\" alt=\"Large Intestine Summary Of The Resections For Carcinoma Colon\" width=\"826\" height=\"351\" srcset=\"https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Summary-Of-The-Resections-For-Carcinoma-Colon.png 826w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Summary-Of-The-Resections-For-Carcinoma-Colon-300x127.png 300w, https:\/\/anatomystudyguide.com\/wp-content\/uploads\/2023\/09\/Large-Intestine-Summary-Of-The-Resections-For-Carcinoma-Colon-768x326.png 768w\" sizes=\"(max-width: 826px) 100vw, 826px\" \/><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Postoperative_Radiotherapy\"><\/span>Postoperative Radiotherapy<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<ul>\n<li>Adenocarcinoma colon does not respond well to radiation. Routinely, it is not given. The small bowel is adjacent to the large bowel so it cannot tolerate high doses of radiation without developing radiation enteritis.<\/li>\n<li>Surgery remains the gold standard for carcinoma colon. Soft tissue infiltration into the psoas muscle or abdominal wall or inoperable recurrent tumours are indications for radiotherapy.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"Colonic_Structure\"><\/span>Colonic Structure<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><strong>Colonic Structure Causes:<\/strong><\/p>\n<ol>\n<li><strong>Malignant:<\/strong> Adenocarcinoma colon is the commonest cause of stricture colon (rarely lymphomas, carcinoid).<\/li>\n<li><strong>Tuberculosis:<\/strong> Uncommon cause of stricture in the ascending colon.<\/li>\n<li><strong>Ischaemic:<\/strong> Uncommon\/rare cause\u2014left colon may be affected.<\/li>\n<li>Inflammatory bowel disease: Any ulcers, including amoebic, may heal with fibrosis resulting in stricture.<\/li>\n<li>Diverticular stricture<\/li>\n<li>Radiation stricture<\/li>\n<li>Endometriomas: Ectopic endometriosis tissue responds to cyclic hormonal stimulation causing inflammation and fibrosis.<\/li>\n<\/ol>\n<p><strong>Colonic Structure Clinical Features:<\/strong><\/p>\n<ul>\n<li>Progressive constipation<\/li>\n<li>Change in bowel habits<\/li>\n<li>Bleeding per rectum<\/li>\n<li>Features of large bowel obstruction<\/li>\n<li>Mass may\/may not be felt<\/li>\n<\/ul>\n<p><strong>Colonic Structure Investigation: <\/strong>Colonoscopy and biopsy<\/p>\n<p><strong>Colonic StructureTreatment:<\/strong><\/p>\n<ul>\n<li>Single-stage resection and end-to-end anastomosis.<\/li>\n<li>Treatment of the cause.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Large Intestine Surgical Anatomy The large intestine extends from the ileocaecal valve to the anus. It has five segments: Right colon, left colon, transverse colon, sigmoid colon, rectum and anal canal The average length is about 135\u2013150 cm. Interestingly, alternating portions of the colon are mobile and fixed. The ascending colon and descending colon are [&hellip;]<\/p>\n","protected":false},"author":9,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[53],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v21.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Large Intestine Surgical Anatomy Notes - Anatomy Study Guide<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/anatomystudyguide.com\/large-intestine-surgical-anatomy-notes\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Large Intestine Surgical Anatomy Notes - Anatomy Study Guide\" \/>\n<meta property=\"og:description\" content=\"Large Intestine Surgical Anatomy The large intestine extends from the ileocaecal valve to the anus. 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