GrosS LARGE BOWEL DR N P TIWARIPresentation Transcript
Gross presentation –bowel loop
• Forms three sided frame
around SI leaving inferior
area open to the pelvis.
• Approx. 1.5 m in length &
extend from lleum to anus.
• Diameter dec from caecum
(7cm) to sigmoid colon
• Divided into 4 segmentscecum,colon,rectum & anus.
Types of bowel resection
Low anterior resection.
• Weigh & measure the specimen
• Sample lymph nodes, & remove the mesentry
while the specimen is fresh.
• Two options are there:A) Open the bowel longitudinally, pin on a
corkboard & fix it overnight.
B)Injecting formalin through one end when the
other end is tied, then tying off the injected end.
• Take photographs .
• In cases with deep penetration by
tumor, dissect the veins carefully for possible
• Part of bowel removed & length of specimen .
• Mucosa- type of lesion,extent,ulceration(linear or
• Wall thickening (focal or diffuse),atrophy
• Serosa- fibrin, pus,fibrosis,adherence of mesentry.
• Diverticulum- number, size, location in relation to
teniae,content, evidence of inflammation, hemorrhage
Description for tumor
• size (including thickness).
• Shape (fungating,flat,ulcerating)
• Extent through bowel wall
• Serosal involvement,satellite nodules.
• Areas of necrosis & hemorrhage.
• Evidence of blood vessel invasion & invasion of
• Distance of tumor to each line of resection.
• Estimate the no. of lymph nodes
found, whether or not nodes appear to be
involved by tumor, size of largest node.
Sections for histology
For non tumoral conditions:• As many as necessary to sample abnormal areas.
• Proximal & distal lines of resection in cases of colitis.
• Appendix, if included in specimen.
For tumoral conditions:• 3 sections from tumor.
• Representative section of subserosal connective
tissue, fat & blood vessel around tumor.
• Both surgical margins.
• Bowel b/w tm & distal line of resection.
• Appendix if included in the specimen.
• Lymph nodes:A) around tumor.
B)distal to tumor.
C)proximal to tumor.
D)at high point of resection(areas surrounding
• In abdominoperineal resections:- anorectal