Diseases of the colon

Definition

These are illnesses of the colon or large intestine which may or may not be cancerous. The main diseases are cancer, diverticular sigmoiditis and a few rare illnesses requiring resection of the colon.

Purpose of surgery

Three main aims

remove the diseased part of the colon
resume normal digestive functions
avoid an artificial anus

This is relatively frequent. It can be cured if it is screened and treated in time. Screening is done by colonoscopy (an examination of the inside of the colon with an endoscope carried out under general anaesthetic and requiring the patient to stay in hospital for half a day). Screening is proposed for patients who have a member of the family suffering from colon cancer and in the event of any bleeding from the anus.

Nontumoral diseases of the colon

The most frequent is sigmoidal diverticulosis. These are diverticula, or pouches which form small hernias in the colon wall.
It can lead to pain in the left side of the lower abdomen, sometimes with fever. An attack may respond to medical treatment combining antibiotics and a strict diet.

It can also be complicated by an occlusion or an abscess, both conditions requiring a stay in hospital and treatment which may be purely medical, radiological or even require an emergency operation with a high risk of having to create a temporary artificial anus.

Other nontumoural diseases

Other nontumoral diseases affecting the colon are much more rare. They are so-called inflammatory illnesses : hemorrhagic rectocolitis and Crohn's disease.

Symptomatology

Diverticular illness may be latent or lead to pain in the left side of the lower abdomen, or occasionally constipation. In 15 % of cases, and especially above the age of 60, the diverticula may become inflamed to give sigmoidal diverticulosis. This is what is sometimes known as "left-hand appendicitis", with fever, pain on the left and is highly sensitive to palpation.

Complications

-Abscess : very high fever and elective pain on the left.

-Peritonitis : very high fever also, and pain throughout the abdomen.

-Fistula : this is a passageway created by the disease between the colon and another organ, usually the bladder, and causing urinary complaints (infection, burning during micturition).

-Pseudotumour diverticulosis : these are signs comparable to those produced by a tumour: occlusion or mass in the lower left abdomen.

-Haemorrhaging : this is rarely serious in sigmoiditis.
Occlusion: the patient cannot pass stools or gas.

THE OPERATION

Introduction :

The operation involves removing the diseased part of the colon and re-establishing continuity so that there is no need to create an artificial anus. This is a frequently performed operation with a low rate of complications. It is done today by laparoscopy in centres experienced in using this technique which involves making small orifices in the abdomen which lead to scars no bigger than for appendicitis.

The day before the operation :

- The colon is "prepared": a purge is given in the form of a liquid drunk by the patient so that no material remains inside the colon which is then "clean".

The day of the operation :

- The patient takes a shower with antiseptic and his/her abdomen is coated with antiseptic.
- Anti-thrombosis stockings are provided..
- An anticoagulant is injected to prevent the risk of phlebitis, on the morning of the operation.
- Premedication.

The operation :

The operation is carried out under general anaesthetic..
It takes from 1 to 2 hours

In most cases, the operation is performed by laparoscopy: the colon is removed via three 10 to 15 mm holes and a scar as for appendicitis.

The advantage of this technique is that the patient returns to his/her normal way of life more quickly. The surgeon may, however, decide to make a conventional incision if he encounters difficulties during the operation.

The operation involves removing the diseased part of the colon and joining the remaining part to the rectum by making an anastomosis, or suture of the colon onto the rectum. This used to be done by sewing the colon and is now performed using automatic clips which staple the colon making the suture safer.

After the operation :

The purpose of this phase is to make sure there are no complications so the patient can return to his/her normal way of life. This phase begins in the recovery room, continues on the hospital ward and finally through a period of convalescence at home.

When the operation is over, you are moved to the recovery room for at least 2 hours. Your state of consciousness, your pulse, your oxygen saturation, your breathing and any drainage tubes are all monitored. In exceptional circumstances, you may also have a nasogastric tube: a pipe going through the nose into the stomach to keep it clear. You may also have drainage tubes: pipes which vacuum away any secretions which might build up in the stomach. And you will have a catheter to monitor your daily urine output.

Returning to the ward :

In the evening or on the day following the operation you will be got out of bed.

Any tubes or drains will be progressively removed over the following days

Your stay in hospital will be from 3 to 8 days after the operation.
You begin eating again progressively, generally the evening after the operation, starting with drinks and then solid food little by little
Dressings are regularly checked.

Resumption of intestinal transit, denoted by the emission of gas, is a very important stage indicating a return to normal function.

Returning home :

During your convalescence, you will be able to eat normally. There is no need for a special diet.

Progressively, you can get back into your usual routine:
After 3 weeks if you have been operated on by laparoscopy.

If you have been operated on using laparatomy, i.e. with a conventional incision, you will have to wear an abdominal belt and you will need an average of 4 to 6 weeks before you can return to a normal routine requiring physical effort.

Consequences and complications

During ablation of the sigmoid colon, known as sigmoidectomy, the rest of the colon takes over the function initially performed by the sigmoid colon.

For a while, your intestinal transit may be modified, but as before the operation, there were frequently transit problems, normal transit will be resumed progressively.

Complications arising as a result of the operation

These are the same as with any form of surgery. Phlebitis, pulmonary embolism, haemorrhage and infection may occur. During the operation, it may in exceptional circumstances be necessary to open the abdomen to control haemorrhaging, for example.

Of complications specific to colon surgery, the following may be encountered:

- Injury to the ureter : the ureter leads urine from the kidney to the bladder and is very close to the sigmoid colon. It may occasionally be injured or require an intervention from a urologist.

- Excessively fragile anastomosis : a suture performed in difficult conditions on diseased organs may be deemed to be too fragile. In this case, a temporary artificial anus is created to protect this suture while it is healing. This anus is closed up on average two months later.

- Rupture of the anastomosis : this can occur immediately after the operation and requires a second operation to create a temporary artificial anus.

- Abscess of the intestinal wall : colon surgery is at high risk from infection, as the colon is an organ colonised by bacteria. Treatment of the intestinal wall abscess is simple and in exceptional circumstances may require a second operation.

Taken together these complications may appear dramatic, but remain unusual for trained staff.

Long-term surveillance

This chapter concerns any consultations which may be necessary after an operation on the colon.