Several diseases can interfere with the normal functioning of the colon. These diseases can have various effects and are traditionally classified as benign (non-cancerous) or malignant (cancerous) and can cause various symptoms including bleeding, infection, and perforation.
In some cases, doctors treat the disease by removing a segment of the colon. Given that the average human has 8-10 feet of small bowel and 3-5 feet of colon, removal of a segment will generally not effect normal functioning of the colon.
In Crohn’s disease, inflammation causes cells in the affected areas of your intestine to secrete large amounts of water and salt. Because the colon can't absorb this excess fluid, you develop diarrhoea. Altered intestinal contractions also can contribute to loose stools. Diarrhoea can range from mild to severe.
Diarrhoea can also be a symptom of ulcerative colitis. However, patients with ulcerative colitis tend to experience bloody diarrhoea and also something called tenesmus. Tenesmus is the sensation of having to move ones’ bowels.
Food moving through your digestive tract can cause inflamed tissue to bleed, and your bowel may also bleed on its own. You might notice bright red blood in the toilet bowl or darker blood mixed with your stool. Should this occur, you must notify your physician.
The risks of any surgery must be weighed against the risks associated with disease state requiring the intervention.
In the case of ulcerative colitis, the risks of ongoing inflammation, infection and subsequent colon cancer are sometimes greater than the risks described below and surgery is thus indicated.
Major risks of laparoscopic proctocolectomy with ileoanal J pouch for ulcerative colitis can include but are not limited to:
Diverticulitis is a common gastrointestinal disorder found mainly in the left side of the large intestine, primarily the sigmoid colon. Diverticulitis develops from a condition called diverticulosis, which involves the formation of outpouches of the colon wall. Diverticulolsis is quite common and tends to occur after the age of 50. Diverticulitis results if one or more of these pouches (or diverticula) becomes inflamed. While left sided involvement is the rule, some patients may have diverticulosis and subsequent diverticulitis on the right side of the colon.
Risk factors believed to be important for developing diverticulosis includes: aging, low fibre diet and possibly lack of exercise. There are no known factors that cause diverticulosis to become diverticulitis.
Patients may also complain of nausea or diarrhoea; others may be constipated.
Other symptoms could include: vomiting, bloating, bleeding from your rectum, frequent urination, and difficulty or pain with urination.
Patients with the above symptoms are commonly studied with a computed tomography, or CT scan. The CT scan is very sensitive (it will detect 98% of all patients with diverticulitis).
Your doctor may also choose to obtain a barium enema. In this test, x-ray dye (barium) is injected through the rectum and pictures are taken to study the inside of the colon. While this test is sensitive for the diagnosis, it does not give information about the overall extent of the disease.
Your doctor should discuss the reasons for choosing one of these tests versus another.
A first time episode of diverticulosis is usually treated with conservative medical management, including bowel rest (i.e., ranging from nothing by mouth to liquids only), intravenous fluid, and antibiotics. Depending on the severity of your attack, this treatment plan may or may not require hospital admission.
Once your pain begins to resolve, most patients will be placed on a low residue diet. This low-fibre diet gives the colon adequate time to heal without needing to be overworked. Later, patients are typically placed on a high fibre diet as there is some evidence this lowers the risk for second and third attacks, known as recurrence.
Patient suffering one-time attacks typically do not require surgery so long as the attack resolved with medical therapy. Recurring attacks or more severe first-time cases may require surgery, either immediately or on an elective basis (see below). The decision to perform surgery for diverticulitis is always handled on a patient by patient basis so you should discuss your specific case with your doctor.
In some cases, surgery may be required to remove the area of the colon most affected by the disease. For example, if the involved segment is the sigmoid colon, the procedure is known as a sigmoid colectomy.
You should understand that segmental colectomy only involves removing the infected or thickened area. Surgeons routinely leave other areas of diverticulosis behind to avoid removing large amounts of your colon. Only 4% of people who have surgery will have a repeat attack in the remaining bowel. However, repeat surgery is not usually warranted.
When is Surgery Indicated?
In more emergent cases, when there has been perforation to the intestine from diverticulitis, two operations are usually involved.
More typically, elective surgery for diverticulitis occurs. As discussed above, this is called segmental colectomy and can be performed either open or laparoscopically.
In open surgery, a large abdominal incision is made. Through this incision the surgeon is able to remove the diseased intestine. Once the diseased bowel is removed the remaining colon is reconnected. With this, the patient is able to have normal bowel movements, the same as before the surgery.
In laparoscopic surgery, 3-5 small incisions are made in the abdominal wall through which instruments and a viewing tube (laparoscope) are inserted. A camera attached to the viewing tube sends images of the inside of the abdomen to a television screen. The surgeon looks at the screen to see what he or she is doing while using the instruments to perform the surgery.
Recent studies show that when laparoscopic colectomy is performed by an appropriately trained surgeon, the short- and long-term outcomes are better than with open surgery. This stems from shorter recovery time, reduced length of hospital stay and earlier return to daily activities. You should ask your surgeon about this approach and about his personal skill level and experience with laparoscopic colectomy.
The risks of any surgery must be weighed against the risks associated with disease state requiring the intervention. In the case of recurrent complicated diverticulitis, the risks of ongoing inflammation and infection are greater than the risks described below and surgery is thus indicated.
Colorectal cancer is cancer of the large intestine (colon), the lower part of your digestive system. Rectal cancer is cancer of the last part of your colon. Together, colorectal cancer is the #2 cause of cancer-related deaths in the United States (second to lung cancer.)
In most cases of colon cancer, the process begins in the form of a polyp. These are benign (non-cancerous) clumps of cells that are often small, and produce few symptoms other than silent and slow bleeding (which may manifest as dark stool.)
It is not possible to distinguish adenomatous from hyperplastic polyps in the body so the current standard of care is to completely remove any colon polyps to permit complete analysis.
On occasion, it may be found that colon cancer has already developed in a removed polyp. In such cases, if the cancer has been completely removed, no further tissue removal is necessary. In cases where residual cancer is left, or if there is uncertainty if cancer cells remain, removal of the affected portion of the colon is indicated (see below.)
Screening tests, as well as simply lifestyle and diet changes, can greatly reduce your overall risk of developing colon cancer because most polyps can be found and removed before they turn into cancer.
Polyps rarely cause symptoms by themselves. On occasion, polyps may bleed and this will typically manifest as dark or tarry stool. Such a finding should prompt a phone call to your physician.
There are often no symptoms of colorectal cancer during its early stages. When symptoms do occur, they will vary according to the location and size of the cancer.
There are many factors that may influence the development of colon cancer.
Most colon cancers develop from adenomatous polyps, so early and routine screening is very important for detecting colon cancers.
The treatment or combination of treatments depends on the stage or extent of cancer present: location of the cancer, how far the cancer has penetrated into the wall of the bowel, and whether the cancer has spread to the lymph nodes and other parts of your body.
Surgery is the main treatment option for colon cancer.
Segmental Colectomy is a surgical procedure that removes the part of your colon that contains the cancer, plus a margin of healthy colon on either side to make sure no cancer is left behind. The two ends of colon are typically then reconnected.
Traditionally, surgery for colon cancer has been done through one large incision in the abdomen. More recently, several large scale studies have been done to prove that laparoscopic surgery can be used to safely remove colon cancer and reattach the ends.* This is known as a laparoscopic colectomy. In each of the studies, researchers have shown that colon cancer patients treated by laparoscopic colectomy have the same propensity for survival as those treated with open colectomy but receive all the benefit of the quicker recovery of a laparoscopic operation.
In laparoscopic colectomy, surgeons utilise special instruments and cameras that are inserted inside the body through multiple small incisions, rather than one large incision. Patients usually recover faster after this technique and leave the hospital earlier on average than patients who choose open surgery. The cosmetic benefits also apply. Not everyone is a candidate for laparoscopic colectomy. People who have large tumours or those who have had many abdominal surgeries in the past, may not be candidates for this technique. This should be discussed with your surgeon as the decision is always dependent on your unique situation and your surgeon's level of comfort.
The risks of any surgery must be weighed against the risks associated with disease state requiring the intervention. In the case of polyps or cancer, the risks of developing or leaving known cancer in the body are greater than the risks described below and surgery is thus indicated.
Radiation is typically reserved for patients with rectal cancer only because it is dangerous to radiate the small bowel that comes in contact with the areas of the colon other than the rectum. Radiation therapy involves treatment with powerful energy rays that kill cancer cells.
If the cancer is large or if the cancer’s location makes surgical treatment difficult, radiation therapy may shrink the tumour before surgery.
This allows high energy rays to focus directly onto the tumour. This technique is more frequently used with rectal cancer, prostate cancer, and in older or ill patients who would not be able to withstand surgery.
Radiation therapy causes several side effects: nausea, skin irritation, diarrhoea, rectal or bladder irritation, or fatigue.
Also known as “chemo” and is the use of drugs that kill cancer cells. They may be given intravenously or taken by mouth. The drugs penetrate through the bloodstream, making them effective for cancers that have spread throughout the body.
Chemotherapy after surgery can increase the survival rate for some patients with invasive colorectal cancer. However, there are negative aspects to chemotherapy as well. While killing cancer cells, chemotherapy drugs can also damage normal, healthy cells too.
Most side effects (such a hair loss) will resolve when chemotherapy is completed.
These drugs target the special defects that allow cancer cells to grow and proliferate. Currently, there are 3 drugs available to patients with advanced cancers and are still experimental.
When caught early colorectal cancer is one of the most preventable and curable cancers. Because so many polyps are left untreated, colorectal cancer is now the third most common cancer in men and women. Each year there are more than 153,000 new colorectal cancer cases and more than 52,000 deaths related to colorectal cancer**.
* COST Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050-2059.,Veldkamp R, Kuhry E, Hop WC, et al;
Colon Cancer Laparoscopic or Open Resection Study Group. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of randomised trail. Lancet Oncol. 2005;6:477-484., Guillou PG, Quirke P, Thorpe H, et al.
Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trail): mulicentre, randomised controlled trial. Lancet 2005;356:1718-1726.
** www.cancer.gov (National Cancer Institute)
Information on this site should not be used as a substitute for talking with your doctor. Always talk with your doctor about diagnosis and treatment information.