Diverticulums-Bowel cancerClínicas quirúrgicas

Dr. Héctor Manuel Virgen AyalaDr. Benjamin Robles Mariscal

Ponente: Héctor Eduardo Velázquez Domínguez

Diverticulums

http://www.medicinapratica.com.br/tag/diverticulo/

Congenital

Acquired

Meckel (2%)

Jejunum/Ileum 15%

Colon (50%)

Type

Pathologies

• Diverticular disease (symphtomatic diverticulum)

• Diverticulosis (diverticulum without inflamation)

• Diverticulitis (inflamation and infection)

Meckel diverticulum

http://www.pedsurg.com.pe/El_diverticulo_de_meckel.php

• 2%

• M 3:2 F

• Congenital real diverticulum

• Faulty onfalomesenteric duct obliteration

• Ileum-1m ileocecal valve

http://scielo.sld.cu/img/revistas/rpr/v9n1/f0111105.jpg

Faulty onfalomesenteric duct obliteration

Cells

• Gastric (60%)

• Pancreas

• Brunner glands

• Colon

• Endometrial

• Hepatobiliary

60% heterotopic mucosa

Clinical presentation

• Usually asymptomatic

• 4% complications (50% <10 â)

• Appendicitis like!

http://www.aurorahealthcare.org/yourhealth/healthgate/getcontent.asp?URLhealthgate=%22127569.html%22

Complications• Hemorrhage (50% <18â)

• Diverticulitis (more common in adults)

• Obstruction

• Perforation

• Volvulus

• Intussusception

SCHWARTZ PRINCIPIOS DE CIRUGIA (8ª ED.) BRUNICARDI, F.MCGRAW‐HILL / INTERAMERICANA DE MEXICO

http://www.revistahnrg.com.ar/pdf_contenidos/con194‐89.pdf

http://www.elsevier.es/sites/default/ciles/elsevier/images/288/288v73n04/grande/288v73n04‐13149799cig1.jpg

Acquired diverticulum

• False diverticulum

• Duodenum near the ampulla

• Jejunum-big and multiple

• Ileum-small and solitary

• Colon (sigmoid)-between tenias/vessels

Jejunum/ileum diverticulum

• 56-76 â

• Traction, muscular weakness and bacteria

• 6-10% symphtomatic

• Intermittent pain, flatulence, diarrhea (10-30%)

• Same complications as Meckel

• Duodenal: compression choledocus or Wirsung

Colon diverticulum

• >50 â (50%)

• Pulsion, low fiber

• most are asymphtomatic

• Left side pain

• Fieber, leukocytosis

• Same complications as Meckel

Dx/Tx• Enteroclysis

• Endoscopy

• Barium enema

• Qx

• Diverticulectomy

• Segmental resection

SCHWARTZ PRINCIPIOS DE CIRUGIA (8ª ED.) BRUNICARDI, F.MCGRAW‐HILL / INTERAMERICANA DE MEXICO

http://www.youtube.com/watch?v=9S1Xn0Kk4kY

Polyposis

http://mingaonline.uach.cl/scielo.php?pid=s0718‐28642007000100009&script=sci_arttext

Classification

• Neoplasic

• Hamartomatous (youth)

• Inflammatory

• Hyperplastic

• ¡Most of carcinomas evolve from polyps!

SessilePedunculated

Neoplasic

• Villous adenoma (40%)

• Tubulovillous adenoma (22%)

• Tubular adenoma (5%)

http://www.boloncol.com/images/stories/boletin15/colon3.jpg

http://escuela.med.puc.cl/publ/patologiageneral/patol_097.html

Hamartomatous

• Rarely premalignant

• Familiar juvenile polyposis (colon and rectum)

• Peutz-Jeghers syndrome (small intestine, less colon and rectum)

http://www.ngoaikhoathuchanh.info/vn/chitiettintuc.aspx?IDTT=1042011113514&IDLOAI=266201002348

Inherited cancer

• Familiar adenomatous polyposis (100%)

• Lynch syndrome (no polyps)

http://www.elsevier.es/sites/default/ciles/elsevier/images/288/288v74n04/grande/288v74n04‐13147781cig1.jpg

Jejunum and ileum cancer

Statistics

• 1.5% gastrointestinal tract tumor

• 10% symptomatic (75% malign)

• 80% metastasis at diagnosis

• 25% 5 year survival

• 5th-6th decade

• Adenocarcinoma 35-50%

• Carcinoid tumor 20-40%

• Lymphoma 10-15%

• GIST 10-15%

http://www.mdsaude.com/2010/07/polipos‐intestinais.html http://emedicine.medscape.com/article/179284‐overviewhttp://www.gastrointestinalatlas.com/

• Red meat

• Smoked food

• Crohn disease

• Celiac sprue

• Polyps

• FAP

• Lynch syndrome

• Peutz-Jeghers syndrome

Risk factors

http://www.cocinerosonline.com/blog/?page_id=499

Clinical presentation

AsymptomaticParcial or total obstruction

(25%)Palpable mass (25%)

Colicky abdominal painDistension

Nausea and vomitingHemorrhage

http://milennium.net/aikiblog/wp‐content/uploads/2010/09/dolor‐abdomen.jpg

• Enteroclysis

• Endoscopy

• Endoscopy capsule

• 5-HIAA (carcinoid tumor)

Diagnosis

SCHWARTZ PRINCIPIOS DE CIRUGIA (8ª ED.) BRUNICARDI, F.MCGRAW‐HILL / INTERAMERICANA DE MEXICO

Treatment resection

http://www.portalesmedicos.com/publicaciones/articles/889/2/

Colon cancer

Statistics

• Most common GI

• 95% Adenocarcinoma

• 5th-6th decade of life

• PAF and CCHSP (20%)

Location

Risk factors

• Same as jejunum and ileum cancer

• Smoking and alcohol

• Poor fiber intake

• High saturated fat intake

AINEVitamin DExcersise

Symptoms

• Left colon:Changes in bowel habitsBlood in stoolObstructive symptoms

• Right colon:WeaknessAnemiaHidden blood in stoolDispeptic symptomsRight disconfortPalpable mass

Laboratory testsUrinalysis

CBC (biometría hemática)Carcinoembryonic antigen

(ACE)70% colon Cancer

detect recurrences after resection

RadiologyRx

Barium enemaColonoscopy

TACSigmoidoscopy

Endorectal ultrasound

http://hnsebimagenes.blogspot.com/2009/01/cncer‐de‐colon‐derecho.html

Treatment

Resection

PaliativeElectrocoagulation

Fotocoagulation with laserSplints-endoferulas

Adjuvant and neoadjuvant therapyRadio and quimio

Staging: TNM

http://www.youtube.com/watch?v=hycQvTO0C24

Thanks