Case Report Procedures Include Rectal Examination, Proctoscopy and Abdominal Radiography
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Practice Parameters for the Treatment of Patients with Dominantly Inherited Colorectal Cancer
Practice Parameters For The Treatment Of Patients With Dominantly Inherited Colorectal Cancer Diseases of the Colon & Rectum 2003;46(8):1001-1012 Prepared by: The Standards Task Force The American Society of Colon and Rectal Surgeons James Church, MD; Clifford Simmang, MD; On Behalf of the Collaborative Group of the Americas on Inherited Colorectal Cancer and the Standards Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons is dedicated to assuring high quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The standards committee is composed of Society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This Committee was created in order to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive, and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. Practice Parameters for the Treatment of Patients With Dominantly Inherited Colorectal Cancer Inherited colorectal cancer includes two main syndromes in which predisposition to the disease is based on a germline mutation that may be transmitted from parent to child. -
Utility of the Digital Rectal Examination in the Emergency Department: a Review
The Journal of Emergency Medicine, Vol. 43, No. 6, pp. 1196–1204, 2012 Published by Elsevier Inc. Printed in the USA 0736-4679/$ - see front matter http://dx.doi.org/10.1016/j.jemermed.2012.06.015 Clinical Reviews UTILITY OF THE DIGITAL RECTAL EXAMINATION IN THE EMERGENCY DEPARTMENT: A REVIEW Chad Kessler, MD, MHPE*† and Stephen J. Bauer, MD† *Department of Emergency Medicine, Jesse Brown VA Medical Center and †University of Illinois-Chicago College of Medicine, Chicago, Illinois Reprint Address: Chad Kessler, MD, MHPE, Department of Emergency Medicine, Jesse Brown Veterans Hospital, 820 S Damen Ave., M/C 111, Chicago, IL 60612 , Abstract—Background: The digital rectal examination abdominal pain and acute appendicitis. Stool obtained by (DRE) has been reflexively performed to evaluate common DRE doesn’t seem to increase the false-positive rate of chief complaints in the Emergency Department without FOBTs, and the DRE correlated moderately well with anal knowing its true utility in diagnosis. Objective: Medical lit- manometric measurements in determining anal sphincter erature databases were searched for the most relevant arti- tone. Published by Elsevier Inc. cles pertaining to: the utility of the DRE in evaluating abdominal pain and acute appendicitis, the false-positive , Keywords—digital rectal; utility; review; Emergency rate of fecal occult blood tests (FOBT) from stool obtained Department; evidence-based medicine by DRE or spontaneous passage, and the correlation be- tween DRE and anal manometry in determining anal tone. Discussion: Sixteen articles met our inclusion criteria; there INTRODUCTION were two for abdominal pain, five for appendicitis, six for anal tone, and three for fecal occult blood. -
Rectal Foreign Body: a Primer for Emergency Physicians Bobby Desai
Desai International Journal of Emergency Medicine 2011, 4:73 http://www.intjem.com/content/4/1/73 CASEREPORT Open Access Visual diagnosis: Rectal foreign body: A primer for emergency physicians Bobby Desai Abstract We present a case that is occasionally seen within emergency departments, namely a rectal foreign body. After presentation of the case, a discussion concerning this entity is given, with practical information on necessity of an accurate and thorough history and removal of the object for clinicians. Case anoscope inserted. The object could not be visualized, A 39-year-old male presented to the Emergency Depart- and therefore no attempt was made to remove it. Gen- ment with vague complaints of abdominal pain and con- eral surgery was consulted to see the patient and stipation. He stated that the abdominal pain was dull decided to take him to the operating room for removal. and crampy in nature and generalized in distribution. The patient agreed to this. Furthermore, he stated that he had not had a bowel The object was noted to be the extension arm of a movement in 2 days, though he felt as if he had to have vacuum cleaner. It was removed according to notes with one. He denied constitutional complaints of fevers, some difficulty and the patient was admitted to the hos- chills, nausea, and vomiting, and denied urinary com- pital for observation and intravenous antibiotics. The plaints as well. patient was subsequently discharged 2 days later in The patient’s vital signs were: temperature 37.2°C, excellent condition. Upon social work discharge, he was pulse 87 beats per minute, respiratory rate of 20 per again asked how that apparatus managed to be placed minute, and blood pressure 130/84 mmHg. -
Endoscopy Rotation Coordination and Goals and Objects Department of Surgery Stanford School of Medicine (8/15/17, Jnl)
Endoscopy Rotation Coordination And Goals and Objects Department of Surgery Stanford School of Medicine (8/15/17, jnl) Rotation Director: James Lau, MD ATTENDINGS and CONTACT INFORMATION Cell Phone E-mail Address James Lau, MD (702) 306-8780 [email protected] Homero Rivas, MD MBA (972) 207-2381 [email protected] Dan Azagury, MD (650) 248-3173 [email protected] Shai Friedland, MD [email protected] Andrew Shelton, MD [email protected] Natalie Kirilcuk, MD [email protected] Cindy Kin, MD [email protected] Laren Becker, MD [email protected] Jennifer Pan, MD [email protected] Suzanne Matsui, MD [email protected] Ramsey Cheung, MD [email protected] KEYPOINT The key for this rotation is that you need to show initiative. TEXT Practical Gastrointestinal Endoscopy: The Fundamentals. Sixth Edition. By Peter B. Cotton, Christopher B. Williams, Robert H. Hawes and Brian P. Saunders. You are responsible for the material to enhance your understanding and supplement your past experiences. Lots of pictures and tips and tricks. Quick read. Copy of text available for purchase on Amazon.com or for check out from the Lane Library. Procedure Schedule Monday Tuesday Wednesday Thursday Friday Laren Becker Jennifer Pan Shelton/Kirilcuk/Kin Ramsey Suzanne (VA (VA Colonoscopy 8:00 am Cheung (VA Matsui (VA Livermore) Livermore) (Stanford Endoscopy) Livermore) Livermore) Every other Tuesday Rivas/Lau alternating Upper/Occasional Lower 1 Endoscopy 9a-1p (Stanford Endoscopy) Suzanne Matsui (VA Livermore) The Staff Drs. Becker, Cheung, Pan, and Matsui are gastroenterologists that perform 75% colonoscopies and 25% upper endoscopies at the Livermore location for the Palo Alto VA. -
The American Society of Colon and Rectal Surgeons' Clinical Practice
CLINICAL PRACTICE GUIDELINES The American Society of Colon and Rectal Surgeons’ Clinical Practice Guideline for the Evaluation and Management of Constipation Ian M. Paquette, M.D. • Madhulika Varma, M.D. • Charles Ternent, M.D. Genevieve Melton-Meaux, M.D. • Janice F. Rafferty, M.D. • Daniel Feingold, M.D. Scott R. Steele, M.D. he American Society of Colon and Rectal Surgeons for functional constipation include at least 2 of the fol- is dedicated to assuring high-quality patient care lowing symptoms during ≥25% of defecations: straining, Tby advancing the science, prevention, and manage- lumpy or hard stools, sensation of incomplete evacuation, ment of disorders and diseases of the colon, rectum, and sensation of anorectal obstruction or blockage, relying on anus. The Clinical Practice Guidelines Committee is com- manual maneuvers to promote defecation, and having less posed of Society members who are chosen because they than 3 unassisted bowel movements per week.7,8 These cri- XXX have demonstrated expertise in the specialty of colon and teria include constipation related to the 3 common sub- rectal surgery. This committee was created to lead inter- types: colonic inertia or slow transit constipation, normal national efforts in defining quality care for conditions re- transit constipation, and pelvic floor or defecation dys- lated to the colon, rectum, and anus. This is accompanied function. However, in reality, many patients demonstrate by developing Clinical Practice Guidelines based on the symptoms attributable to more than 1 constipation sub- best available evidence. These guidelines are inclusive and type and to constipation-predominant IBS, as well. The not prescriptive. -
Perforation Due to a Rectal Foreign Body and Radiological Findings
Case Report Ann Colorectal Res 2021;9(1):44-46. Perforation Due to a Rectal Foreign Body and Radiological Findings Saim Turkoglu1, MD; Adem Yokuş2, MD; Fırat Aslan3, MD 1Van Traınıng and Research Hospıtal, Van, Turkey 2Department of Radiology, Medical Faculty, Yuzuncu Yıl University, Van, Turkey 3Department of General Surgery, Medical Faculty, Yuzuncu Yıl University, Van, Turkey *Corresponding authors: Received: 01-03-2021 Saim Turkoglu, Van Traınıng and Research Hospıtal, Van,Turkey Revised: 03-04-2021 Tel: +90 5356452865; Fax: +90 432 2150471 Accepted: 05-04-2021 Email: [email protected] Abstract Introduction: Rectal foreign bodies have been increasingly seen and cause urgent surgical complications. Diagnosis and treatment of these cases in emergency departments may be difficult. The effective use of radiological imaging techniques can accelerate and facilitate this process. Case Presentation: A 65-year-old male patient, who underwent computed tomography (CT) with the suspicion of a foreign body in the rectum, was admitted to the emergency outpatient clinic. The patient was a male with a psychiatric illness who later underwent emergency surgery. Since the patient had impaired consciousness during the examination, anamnesis could not be obtained, so the initial impression upon surgical consultation was perforation due to rectal tumoral thickening. In almost all cases, plain radiography is sufficient and can eliminate diagnostic difficulties. However, this is not possible for non-opaque objects. Therefore, the CT scan played an important role in the diagnosis of this patient. A 30 cm foreign body, identified as salami, was removed from the abdomen of the patient, who was later taken for emergency surgery. -
Colon and Rectal Surgery Case Log Instructions Review Committee for Colon and Rectal Surgery
Colon and Rectal Surgery Case Log Instructions Review Committee for Colon and Rectal Surgery Background The ACGME Case Log System is a data depository which provides a mechanism that supports programs in complying with requirements, and also provides a uniform mechanism to verify the clinical education of residents among programs. The Case Log System is designed to capture and categorize a resident’s experience with patient care. It was initially instituted in 2001, and the Review Committee for Colon and Rectal Surgery has required its use by accredited programs since 2005. It is the intention of the Review Committee for Colon and Rectal Surgery that each resident has a reasonably equivalent educational experience to prepare for the practice of the specialty. As part of the process, the case numbers for each resident completing a program are collected and analyzed. To accomplish this complex task, a structured database has been created using standard codes for diagnoses and procedures. The Case Log System helps assess the breadth and depth of clinical experience provided to each colon and rectal surgery resident by his or her program with the ultimate goal of improving the programs themselves. It is the responsibility of the individual residents to accurately and in a timely manner enter their case data. The data entered will be monitored by the program directors and analyzed by the Review Committee. Separate analysis reports are created annually for the Committee, for program directors, and for residents. Additionally, the ACGME provides information regarding individual residents’ experience to the American Board of Colon and Rectal Surgery (ABCRS) as one criterion for their admission to the ABCRS’s exam process. -
Chapter 1 History of Laparoscopic Surgery
Chapter 1 History of Laparoscopic Surgery Kiyokazu Nakajima, Jeffrey W. Milsom, and Bartholomäus Böhm Although laparoscopic surgery has transformed surgery only in the past two decades, its evolution is only the natural byproduct of the medical doctor’s curiosity to directly visualize and treat surgical dis- eases. The earliest known attempts to look inside the living human body date from 460 to 375 BC, from the Kos school of medicine led by Hippocrates in Greece.1,2 They described a rectal examination using a speculum remarkably similar to the instruments we use today. Similar specula were discovered in the ruins of Pompeii (70 AD) that were used to examine the vagina, the cervix, and the rectum, and obtain an inside view of the nose and ear.1 The Babylonian Talmud written in 500 AD described a lead siphon, named “Siphophert,” with a mouthpiece, which was bent inward and held a mechul (wooden drain).1,3 The apparatus was introduced into the vagina and was used to differentiate between vaginal and uterine bleeding. During these early years ambient light was used. The term “endoscopein” is attributed to Avicenna (Ibn Sina, 980–1037 AD) of Persia, although an Arabian physician, Albulassim (912–1013 AD), who placed a mirror in front of the exposed vagina, was the fi rst to use refl ected light as a source of illumination for an endoscopic examination. Giulio Caesare Aranzi in Venice (1530–1589) developed the fi rst endoscopic light in 1587. He used the Benedictine monk Don Panuce’s principle of the “camera obscura” for medical purposes – the -
High Quality Fecal Occult Blood Testing (FOBT) for CRC Screening: Evidence and Recommendations
High Quality Fecal Occult Blood Testing (FOBT) for CRC Screening: Evidence and Recommendations Rationale for use of FOBT High sensitivity fecal occult blood testing (FOBT) is one of the colorectal cancer screening methods recommended in guidelines from the American Cancer Society, the US Preventive Services Taskforce, and every other major medical organization. In spite of this widespread endorsement, primary care clinicians often express conviction that colonoscopy is the “gold standard” test for colorectal cancer screening and that the use of FOBT represents sub-standard care. These beliefs persist in spite of well-documented shortcomings of endoscopy (missed adenomas and cancers, higher complication rates and higher one-time costs than other screening methodologies), and the fact that access to endoscopy is limited or non- existent for a significant proportion of the U.S. population. Many clinicians are also unaware that randomized controlled trials of FOBT screening have demonstrated decreases in colorectal cancer incidence and mortality, and modeling studies suggest that the years of life saved through a high quality FOBT screening program are essentially the same as with a high quality colonoscopy based screening programs. Recent advances in stool blood screening include the emergence of new tests and improved understanding of the impact of quality factors on testing outcomes. This document provides state-of-the-science information about high quality stool testing. Types of Fecal Occult Blood Tests Two main types of FOBT are available – guaiac and immunochemical. Both types of FOBT have been shown to have reasonably high detection rates for colon and rectal cancers; adenoma detection rates are appreciably lower. -
ICD~10~PCS Complete Code Set Procedural Coding System Sample
ICD~10~PCS Complete Code Set Procedural Coding System Sample Table.of.Contents Preface....................................................................................00 Mouth and Throat ............................................................................. 00 Introducton...........................................................................00 Gastrointestinal System .................................................................. 00 Hepatobiliary System and Pancreas ........................................... 00 What is ICD-10-PCS? ........................................................................ 00 Endocrine System ............................................................................. 00 ICD-10-PCS Code Structure ........................................................... 00 Skin and Breast .................................................................................. 00 ICD-10-PCS Design ........................................................................... 00 Subcutaneous Tissue and Fascia ................................................. 00 ICD-10-PCS Additional Characteristics ...................................... 00 Muscles ................................................................................................. 00 ICD-10-PCS Applications ................................................................ 00 Tendons ................................................................................................ 00 Understandng.Root.Operatons..........................................00 -
Hybrid Procedure Offers a Less Invasive Alternative to Colectomy
The better way to get better Hybrid procedure offers a less invasive alternative to colectomy Insufflation gas provides important advantage The colonoscopy-laparoscopy procedure is made possible through the combined skills of the gastroenterologist and laparoscopic surgeon, and the use of CO2 rather than ambient air for insufflation — the introduction of gas into the colon to improve visibility. CO2 is more quickly absorbed by the gastrointestinal tract and results in less bowel distension, giving the laparoscopic surgeon a better field of vision within the abdominal cavity. © Copyright Olympus. Used with permission. “Some patients who would have required a bowel resection can instead benefit from this A new, minimally invasive procedure that is a hybrid of colonoscopy and less invasive procedure. We’re laparoscopy is proving to be a safe and effective alternative to open colectomy using this combined technique (removal of part of the colon) for patients with benign colon polyps that are as a way for patients to avoid colectomy,” explains James not removable endoscopically. Yoo, M.D., a colorectal surgeon Patients who undergo this hybrid procedure experience less pain and often go at UCLA. “This procedure home after only one or two days. Scarring and wound complications are minimal involves tiny incisions for the as the laparoscopic surgeon makes only small, keyhole incisions in the abdomen laparoscopic instruments and patients stay in the hospital only rather than the long incision characteristic of a traditional colectomy. a day or two.” WWW.UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) Who can benefit from the procedure? Participating When a routine colonoscopy reveals polyps, they are usually removed at the Physicians time of the procedure as a precaution against their progression to cancer. -
Laparoscopic Sentinel Node Mapping for Colorectal Cancer Using Infrared Ray Laparoscopy
ANTICANCER RESEARCH 26: 2307-2312 (2006) Laparoscopic Sentinel Node Mapping for Colorectal Cancer Using Infrared Ray Laparoscopy KOICHI NAGATA1, SHUNGO ENDO1, EIJI HIDAKA1, JUN-ICHI TANAKA1, SHIN-EI KUDO1 and AKIRA SHIOKAWA2 1Digestive Disease Center and 2Pathology Section, Showa University Northern Yokohama Hospital, Yokohama 224-8503, Japan Abstract. Background: Sentinel lymph node (SN) mapping colectomy (LAC). SNs were mapped by the submucosal by dye injection on conventional laparoscopy (CL) is often injection of dye on intra-operative colonoscopy, or by the precluded by the presence of mesenteric adipose tissue in use of a spinal needle and percutaneous subserosal injection patients with colorectal cancer. SN mapping on CL was of dye at a premarked site (pre-operative tattooing of compared with that on infrared ray laparoscopy (IRL) during polypectomy site with carbon). However, our experience laparoscopy-assisted colectomy (LAC). Patients and indicates that laparoscopic SN mapping by dye injection is Methods: Forty-eight patients with colorectal cancer who technically difficult because injection of the dye into the underwent LAC were enrolled. The tumor was identified by colon wall during LAC is cumbersome. Submucosal intra-operative fluoroscopy with marking clips. The tumor injection of dye on intra-operative colonoscopy makes LAC was stained intra-operatively by peritumoral injection of difficult and problematic. Distension of the small intestine indocyanine green dye. SNs were observed by CL and by IRL. with air on colonoscopy interferes with the operative field Results: In all 48 patients, dye injection and tumor and precludes laparoscopic procedures. Moreover, intra- localization during LAC were successful. The identification operative colonoscopic examinations require considerable of SNs on IRL was approximately five times better than that time, especially in patients with right-sided colon cancer.