Colon Diseases

1. COLON DISEASE: NON SPECIFIC
ULCERATIVE COLITIS, CROHN'S
AND HIRSCHSPRUNG’S DISEASE
Submitted By,
ASHMI KHAN
4THYEAR

2. HIRSCHSPRUNG’S DISEASE
•Known as congenital megacolon
•It occurs in newborn due t the
absence of ganglion cells-
Auerbach’s and Meissner’s plexus
in anorectum.
•It always involves anua, internal
sphincter & rectum

3. •Narrow, spasmodic, non
relaxing pathological
segment
•Its one of the neonatal
intestinal obstruction.
•Severe enterocolitis can
occur that can be fatal.

4. TYPES
ULTRASOUND SEGMENT HD
Only anal canal and terminal rectum is
aganglionic.

5. SHORT SEGMENT HD
Anal canal and rectum is completely involved of
almost 80%

7. LONG SEGMENT HD
Anal canal, rectum and part of thecolon is
involved of almost in 10%

8. TOTAL COLONIC HD
Anal canal, rectum and full length of the colon
is involved of almost 10%

9. 3 ZONES
I. Distal immobile spastic segment that is
aganglionic zone.
II. Proximal middle transitional zone of about
1-5 cm length with less sparse number of
ganglions or cone
III. More proximal hypertrophied dilated
segment is actually normal ganglionic area.

10. CLINICAL FEATURES
• Acute recurrent, chronic
• Most common in males of 80%
• Common in infants and children
• Often associated with down’s syndrome
• In 90% symptoms appear in early neonatal
period within 3 days of birth. The child fails
to pass meconium
• In children there is a passage of goat pellet
like stools, malnutrition, abdominal
distention is chronic type

11. • Constipation, once in 3-4
days with straining is seen
throughout the childhood
• 10% familial
• Gene mutation can occur
in chromosome 10
commonly occasionally
chromosome 13
• Rectal examination shows
tight sphincter with
empty rectum. Child
passes a lot of gas and
meconium

12. DIAGNOSIS
• History of failure of passing
meconium
• Plain Xray abdomen shows
intestinal obstruction useful in
case of perforation
• Biopsy
• Barium enema
• Anorectal manometry
• Acetylcholine esterase staining
shows hypotrophical nerve
bundles

13. COMPLICATIONS
• Colitis
• Intestinal obstruction
• Growth retardation
• Constipation
• Perforation
• Peritonitis
• Septicaemia

14. TREATMENT
• Initially colostomy is done either transverse or transitional
• Nutritional supplements
• Once the child attains kg of weight definitive procedure is done which is
excision of aganglionic segment, maintainance of continuity by doing
coloanal anastomosis, closure of colostomy later
• Common procedures are:
1. Modified Duhamel operation which is a resection of upper part of the
rectum and a part of colon; anastomosis of on to posterior part of the
lower rectum and crushing the spurs to create rectal pouch

15. 2. Soave’s mucosectomy and pull
through operation
3. Coloanal anastomosis after
proctocolectomy
4. Total proctocolectomy with ileo anal
anastomosis in case of totola colonic hd
5. Swenson’s operation through
abdomino anal approach , aganglionic
segment is resected and coloanal
anastomosis is done
6. Anorectal myectomy very useful for
ultra short segment and short segment
hirschsprung’s disease.

16. ULCERATIVE COLITIS
• Inflammatory condition of rectum and
colon of unknown aetiology perhaps
related to stress, westernized diet
autoimmune factor, familial tendency
allergic factor.
• Disease commonly starts in the rectum ,
spreads proximally to the colon and often
into the ileum as back wash ileitis.

17. Aethiological factors
• Westernized diet, red meat less common in vegetarians
• Defective mucin production in the colonic mucosa and mucosal
immunological reaction
• Autoimmune factors- cytotoxic T lymphocytes against colonic
epithelial cells and presence of anticolon antibodies.
• Appendicectomy and smoking protects ulcerative colitis especially
from extraintestinal features & postoperative complications
• Allergy to milk
• Excess reactive oxidative metabolism

18. Pathology

19. CLINICAL FEATURES
• Disease begins in rectum as proctitis later
becomes left sided colitis eventually cause
total proctocolitis
• More common in females
• Watery diarrhoea mucus or blood stained
discharge per rectum
• Colicky pain spasms
• Decreased appetite and loss of weight
• Relapses and remissions at regular intervals

20. 2 PRESENTATIONS
• FULMINANT TYPE 5% COMMON
It is a severe form ,with continuous
diarrhoea with passage of blood, mucus
,pus
Patient is ill and dehydrated
Fever , hypokalamia, acidosis,
dehydration and shock
Abdominal distention occurs
Acute toxic dilatation of transverse
colon

21. CHRONIC TYPE
• Last for months to years with diarrhoea, blood loss, anaemia,
invalidism, abdominal discomfort and pain
• Severe malnutrition and hypoproteinaemia

22. INVESTIGATIONS
• Barium enema
• Sigmoidoscopy and biopsy
• Colonoscopy
• Plain X ray abdomen is useful in
obstruction toxic, megacolon,
perforation.
• C Reactive protein will be very
high in acute phase

23. COMPLICATION
• GIT
• Pseudopolypsis
• Turning into malignancy
• Stricture formation, commonly in recto
sigmoid and anal canal- 10%
• Toxic megacolon in transverse colon
• Massive haemorrhage
• Fistula in anal
• perforation

24. TREATMENT
• Correction of anaemia
• Fluid and electrolyte supplementation
• Nutrition, TPN
• Sedatives and tranquillisers
• Psychological counselling
• Drugs: salazopyrine / sulfasalazine, Mesalamine, steroids,
immunomodulators- azathioprine, cyclosporin, Mebeverine,
olsalazine.

25. CROHN’S DISEASE
• Also known as regional enteritis
Granulomatous, noncaseating
inflammatory condition of ileum
commonly and of the colon

26. AETHIOLOGY
• Unknown, but a familial and infective
nature is thought of
• Increased autoantibodies
• Diet and food allergy
• Slight more common in females
• Focal ischaemia as a vasculitis

27. PATHOLOGY
transmural inflammation
granuloma formation with linear snake like ulcers
cicatrisation
thickening of the bowel wall
adhesion
circulation

28. CLINICAL FEATURES
• Acute presentations: acute appendicitis with diarrhoea
• Chronic crohn’s :
1. First stage :- mild diarrhoea, colicky pain, fever, anaemia, mass in
right iliac fossa which is tender, firm, nonmobile along with
recurrent perianal abscess
2. Second stage :- either acute or chronic intestinal obstruction due
to cicatrisation with narrowing
3. Third stage:- fistula formation- enterocolic, enteroenteric,
enterovesical, enterocutaneous

29. INVESTIGATIONS
• Plain X ray abdomen, ultrasound abdomen
• Barium meal follow through or small bowel
enema
• Straightening of valvulae conniventes
• Multiple defects- cobble stone appearance
• Cicatrisation of ileum
• Rose thorn appearance of the bowel wall
• CT Scan and CT Fistulogram
• MRI to diagnose anal disease

30. TREATMENT
MEDICAL
• Bed rest, protein, vitamin supplementation
• Steroids to induce remission. Methylprednisolone infusion 60mg
• Azathioprine for maintenance therapy.
• Antibiotic like 5- amminosalicylic acid
• Metronidazole
• Monoclonal antibody like infliximab

31. SURGICAL INDICATIONS
• Failure of medical treatment
• Intestinal obstruction
• Fistula formation, bleeding, malignant
change
• Perforation, fulminant colitis
• Perianal problems

32. SURGERIES
1. Illeo-caecal resection
2. Segmental resection
3. Total colectomy
4. Stricturoplasty
5. Temporary ileostomy
6. Laparoscopic resection
7. Corrective surgery for
anal disease like fissure