Does a defunctionalized colon develop colitis? Although controversial, some patients with a portion or the entire colon out of the fecal stream develop an inflammation difficult to distinguish from ulcerative colitis on biopsy. The diagnosis of diversion colitis is suggested when bloody mucopus is passed from the separate colorectal segment . The colon may be isolated by …
Pouchitis Pouchitis, one of the most frequent long-term complications of IPAA, is a nonspecific acute or chronic inflammation of the reservoir. Pouchitis is found in 7% to 44% of patients with IPAA; it presents with watery, bloody stools, urgency, frequency, abdominal pain, fever, malaise, and possible exacerbation of extra-intestinal manifestations of inflammatory bowel disease. The …
Elective surgical options for familial adenomatous polyposis and chronic ulcerative colitis Total proctocolectomy with end (Brooke) ileostomy Total proctocolectomy with continent ileostomy reservoir (Kock pouch) Abdominal colectomy with ileorectal anastomosis Near-total proctocolectomy ± rectal mucosectomy and ileal pouch-anal anastomosis (IPAA)
Surgical indications for ulcerative colitis Intractability or failure of medical management Fulminant colitis (toxic megacolon, bleeding, diarrhea) Prophylaxis of carcinoma (presence of high-grade dysplasia) Treatment of carcinoma
How does one screen for FAP? When family history is positive, children should undergo annual sigmoidoscopic surveillance beginning at age 10 to 12 years. When polyps are identified, a full colonoscopy is recommended. Once multiple adenomas are documented, colectomy is recommended. Mutational analysis of the APC gene is the most accurate diagnosis. Ophthalmoscopic examination for congenital hypertrophy …
Gardner syndrome Gardner syndrome is a phenotypic variant of FAP manifest by colonic polyposis plus fibromas of the skin, osteomas (typically of the mandible, maxilla, and skull), epidermoid cysts, desmoid tumors, and extra dentition.
Symptoms of familial adenomatous polyposis (FAP) FAP is an autosomal-dominant, non–sex-linked disease in which more than 100 adenomatous polyps affect the colon and rectum. FAP is caused by mutation in the adenomatous polyposis coli (APC) gene on the long arm of chromosome 5 at the 5q21-q22 locus. The APC protein is a tumor suppressor that, when mutated, fails to …