Proctocolectomy with ileal pouch–anal anastomosis (IPAA) has become the standard restorative procedure for patients requiring surgery for ulcerative colitis. Since the operation's introduction in 1978 by Sir Alan Parks, several refinements have occurred as new medications and technologies have come…
The prototypical inflammatory bowel diseases (IBDs), ulcerative colitis (UC), and Crohn disease (CD), are idiopathic inflammatory disorders of the intestinal tract characterized by a chronic, relapsing course. UC and CD have profound effects on the life of patients and create…
Anorectal suppurative disease may manifest itself in an acute or a chronic setting. Anal sepsis (abscess) represents the acute manifestation, and anal fistula represents the chronic form of the suppurative process. In its simplest form, an anal fistula represents a…
Anal fissure (fissure-in-ano) is a common condition that usually presents as anal pain or bleeding with defecation. It is easily confused with symptomatic hemorrhoids. It can be very troubling because the severity of patient discomfort and extent of disability far…
Hemorrhoids have been referenced in ancient texts dating back 4000 years. Included in many of these Egyptian and Greek writings are multiple recommended treatment regimens including anal dilation, topical ointments, and the intimidating red hot poker. Although few people have…
Diverticulitis is one of the most commonly diagnosed inflammatory conditions of the gastrointestinal (GI) tract. The condition was relatively uncommon a century ago, yet it now results in approximately 300,000 hospital admissions per year, placing it among the top five…
Colonic Bleeding Lower gastrointestinal (GI) bleeding is defined as bleeding that occurs distal to the ligament of Treitz. Patients typically complain of hematochezia or blood clots per rectum. However, lower GI bleeding can be further subdivided into small bowel and…
Colonic Intussusception Pathophysiology Colonic intussusception is a rare diagnosis in adults. This process occurs when a proximal segment of intestine (intussusceptum) invaginates into a distal segment of intestine (intussuscipiens) with 86% to 90% associated with a pathologic lesion as the…
Elective surgical philosophies and techniques are often suboptimal in the injured patient. Unlike planned colorectal operations, where hemorrhage and fecal spillage are immediately addressed, the adverse cascades of infection and shock commence at injury. This inherent delay in presentation, obscuration…
Pilonidal Disease Sacrococcygeal pilonidal disease (PD) has a calculated incidence of 26 per 100,000 people and is a source of morbidity in young adults due to the chronicity of disease and extent of surgical intervention. The current understanding is that…