Current Therapy in Colon and Rectal Surgery

Management of Anastomotic Leak

Introduction Although significant improvements in oncologic outcomes after surgery for colorectal cancer have been achieved, the issue of anastomotic leaks remains a challenge. In fact, an anastomotic leak is one of the most serious complications of any restorative colon or…

Prevention and Management of Sepsis

Background Sepsis is uncontrolled infection—a potentially fatal condition manifested by tachycardia, leukocytosis, fever, and hypotension. In the United States, the overall incidence is estimated to be more than 1.1 million cases per year at an annual cost of $24.3 billion.…

Nutritional Support in Colorectal Surgery

Acknowledgment We gratefully acknowledge Maureen E. Rombeau, MA, for editorial assistance. Introduction Surgeons are justifiably proud of their seminal contributions to nutritional care of the hospitalized patient. These contributions include quantifying the prevalence of malnutrition, confirming the association of malnutrition…

Reoperative Pelvic Surgery

Introduction Reoperative pelvic surgery is one of the most difficult challenges a colon and rectal surgeon can face. Anatomic, postsurgical, and disease-specific factors combine to present unique challenges with significant potential for major morbidity and even mortality. This is not…

Colorectal Surgery in the High-Risk Patient

Introduction Increasing life expectancy coupled with the growing incidence of both benign and malignant colorectal disease has resulted in a greater need for surgeons to operate on patients with a variety of comorbidities. It has been estimated that elderly persons…

Radiation Enteritis and Proctocolitis

Background Radiation was first used as a treatment modality for breast cancer in 1896, and a year later Dr. David Walsh, a physician at the Western Skin Hospital, London, described the first case of radiation enteritis. A “practical worker” had…

Acute and Chronic Mesenteric Ischemia

Introduction Mesenteric ischemia can be either acute or chronic. The acute variant is a life-threatening disease of sudden onset and has several distinctly different causes. Most patients who are diagnosed with acute visceral ischemia have progressed to the point of…

Enterocutaneous Fistulas

Introduction Enterocutaneous fistulas, defined as an abnormal communication between the small bowel and skin, are among the most daunting problems for an intestinal surgeon. The impact of an enterocutaneous fistula on a patient varies from a minor inconvenience to fatal…

Neuroendocrine Tumors of the Small and Large Intestine

Definition Neuroendocrine tumors (NETs) derive from neuroendocrine cells (also called enterochromaffin cells or enterochromaffin-like cells) of the endoderm of the fore-, mid-, and hindgut. These cells are diffusely distributed in the epithelium of the gastroenteropancreatic system, the bronchial system, and…

Small Bowel Neoplasms

Acknowledgment I thank Cory Sandone for her artwork on small bowel neoplasms. Introduction Neoplasms of the small intestine are rare, accounting for 3% to 6% of gastrointestinal neoplasms overall and 1% to 3% of primary gastrointestinal cancers. The incidence of…