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Diverticulums - Bowel cancer
- 1. Diverticulums-Bowel cancer Clínicas quirúrgicas Dr. Héctor Manuel Virgen Ayala Dr. Benjamin Robles Mariscal Ponente: Héctor Eduardo Velázquez Domínguez
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- 3. Type Congenital Meckel (2%) Jejunum/Ileum 15% Acquired Colon (50%)
- 4. Pathologies • Diverticular disease(symphtomatic diverticulum) • Diverticulosis (diverticulum without inflamation) • Diverticulitis (inflamation and infection)
- 5. Meckel diverticulum • 2% • M 3:2 F • Congenital real diverticulum • Faulty onfalomesenteric duct obliteration • Ileum-1m ileocecal valve http://www.pedsurg.com.pe/El_diverticulo_de_meckel.php
- 6. Faulty onfalomesenteric duct obliteration http://scielo.sld.cu/img/revistas/rpr/v9n1/f0111105.jpg
- 7. Cells • Gastric (60%) • Pancreas 60% heterotopic mucosa • Brunner glands • Colon • Endometrial • Hepatobiliary
- 8. Clinical presentation • Usually asymptomatic • 4% complications (50% <10 â) • Appendicitis like! http://www.aurorahealthcare.org/yourhealth/healthgate/ getcontent.asp?URLhealthgate=%22127569.html%22
- 9. Complications SCHWARTZ PRINCIPIOS DE CIRUGIA (8ª ED.) BRUNICARDI, F. MCGRAW‐HILL / INTERAMERICANA DE MEXICO • Hemorrhage (50% <18â) • Diverticulitis (more common in adults) • Obstruction • Perforation • Volvulus • Intussusception http://www.revistahnrg.com.ar/pdf_contenidos/con194‐89.pdf
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- 11. Acquired diverticulum • Falsediverticulum • Duodenum near the ampulla • Jejunum-big and multiple • Ileum-small and solitary • Colon (sigmoid)-between tenias/vessels
- 12. 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
- 13. Colon diverticulum • >50â (50%) • Pulsion, low fiber • most are asymphtomatic • Left side pain • Fieber, leukocytosis • Same complications as Meckel
- 14. Dx/Tx • Enteroclysis • Diverticulectomy • Endoscopy • Segmental resection • Barium enema • Qx SCHWARTZ PRINCIPIOS DE CIRUGIA (8ª ED.) BRUNICARDI, F. MCGRAW‐HILL / INTERAMERICANA DE MEXICO
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- 18. Classification • Neoplasic • Hamartomatous(youth) Sessile • Inflammatory Pedunculated • Hyperplastic • ¡Most of carcinomas evolve from polyps!
- 19. Neoplasic http://www.boloncol.com/images/stories/boletin15/colon3.jpg • Villous adenoma (40%) • Tubulovillous adenoma (22%) • Tubular adenoma (5%) http://escuela.med.puc.cl/publ/patologiageneral/patol_097.html
- 20. 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
- 21. 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
- 22. Jejunum and ileum cancer
- 23. Statistics • 1.5% • 80% metastasis gastrointestinal at diagnosis tract tumor • 25% 5 year • 10% survival symptomatic (75% malign) • 5th-6th decade
- 24. http://www.mdsaude.com/ http://www.gastrointestinalatlas.com/ http://emedicine.medscape.com/article/179284‐overview 2010/07/polipos‐intestinais.html • Adenocarcinoma 35-50% • Carcinoid tumor 20-40% • Lymphoma 10-15% • GIST 10-15%
- 25. Risk factors • Red meat • Smoked food • Crohn disease • Celiac sprue • Polyps • FAP • Lynch syndrome http://www.cocinerosonline.com/blog/?page_id=499 • Peutz-Jeghers syndrome
- 26. Clinical presentation Asymptomatic Parcial or total obstruction (25%) Palpable mass (25%) Colicky abdominal pain Distension Nausea and vomiting Hemorrhage http://milennium.net/aikiblog/wp‐content/uploads/2010/09/dolor‐abdomen.jpg
- 27. Diagnosis • Enteroclysis • Endoscopy • Endoscopy capsule • 5-HIAA (carcinoid tumor) SCHWARTZ PRINCIPIOS DE CIRUGIA (8ª ED.) BRUNICARDI, F. MCGRAW‐HILL / INTERAMERICANA DE MEXICO
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- 30. Statistics • Most • 5th-6th decade common GI of life • 95% • PAF and CCHSP Adenocarcinoma (20%)
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- 32. Risk factors • Sameas jejunum and ileum cancer • Smoking and alcohol AINE • Poor fiber intake Vitamin D • High saturated fat intake Excersise
- 33. Symptoms • Right colon: • Left colon: Weakness Changes in Anemia bowel habits Hidden blood in Blood in stool stool Obstructive Dispeptic symptoms symptoms Right disconfort Palpable mass
- 34. Laboratory tests Urinalysis CBC (biometría hemática) Carcinoembryonic antigen (ACE) 70% colon Cancer detect recurrences after resection
- 35. Radiology Rx Barium enema Colonoscopy TAC Sigmoidoscopy Endorectal ultrasound http://hnsebimagenes.blogspot.com/2009/01/cncer‐de‐colon‐derecho.html
- 36. Treatment Resection Paliative Electrocoagulation Fotocoagulation with laser Splints-endoferulas Adjuvant and neoadjuvant therapy Radio and quimio
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