Lower GI

Colonoscopy :: Polypectomy
Diverticular Disease :: Laparoscopic Colorectal Surgery :: Stomas

Colonoscopy

Colonoscopy is a procedure used to view large intestine (colon and rectum) using an instrument called colonoscope (a flexible tube with a small camera and lens attached). The procedure can detect inflamed tissue, ulcers, and abnormal growths. It is used to diagnose early signs of colorectal cancer, bowel disorders, abdominal pain, muscle spasms, inflamed tissue, ulcers, anal bleeding, and non-dietary weight loss.

The procedure is done under sedation. The colonoscope is inserted into the rectum which gently moves up through the colon until it reaches the cecum (junction of small and large intestine). Colonoscopy provides an instant diagnosis of many conditions of the colon and is more sensitive than X-ray.

The colonoscope is then withdrawn very slowly as the camera shows pictures of the colon and rectum onto a large screen. Polyps or growths can also be removed by colonoscopy which can be sent later for detection of cancer.

Instructions for colonoscopy

Your physician may provide you written instructions and also will be communicate verbally on how to get prepared for the colonoscopy procedure. The process is called bowel prep.

Gastrointestinal (GI) tract should be devoid of solid food; a strict liquid diet should be followed for 1 to 3 days before the procedure. Patients should not drink beverages containing red or purple dye. Liquids that can be taken before surgery include fruit juices, plain coffee, tea, and water.

Certain medications such as aspirin, ibuprofen, naproxen or other blood thinning medications, iron containing preparation should be stopped before the test. Iron medications produce a dark black stool, and this makes the view inside the bowel less clear.

The day before colonoscopy you are quite to undertake bowel preparation to cleanse the colon. This consists of 2 sachets of Picolax and 2 sachets of Colonlytely. (Please refer to link to Instructions for colonoscopy). This is to eliminate any residue in the colon. The success of your examination depends on the bowel being as clear as possible; otherwise the examination may need to be repeated.

Driving is not permitted for 12 hours after colonoscopy.

Polypectomy

Polypectomy is surgical removal of a polyp. Polyps are non-cancerous abnormal growth of the tissue along the lining of gastrointestinal wall. Gastrointestinal polyps can be removed endoscopically through colonoscopy or surgically if the polyp is too large. During colonoscopy, the polyps are identified and cut using forceps.  Larger polyps are removed by passing a wire snare, tightening the snare around the polyp base and then burning with electric cautery.  Polyps that are removed through colonoscopy are sent for further analysis or to detect cancer. Polypectomy is safe and is not associated with serious complications and risks.  The most common risks associated with polypectomy are perforation and bleeding.

Call your doctor if you observe side effects such as severe abdominal pain, fever, blood in stools, dizziness, and weakness.

Diverticular Disease

Diverticular disease is a common disorder of the large intestine (colon) which involves two conditions namely diverticulosis and diverticulitis. Diverticulosis is a condition which occurs commonly in individuals aged 40 and above where small pouches form in the lining of the large intestine. These are often the weak spots. When these pouches are inflamed, the condition is known as diverticulitis. Diverticulosis and diverticulitis combined together is the diverticular disease.

A low-fiber diet is often the cause for diverticular disease. Lack of fiber content in the food we eat makes the stools very hard, resulting in constipation. You may need to strain a lot during bowel movement, which may cause the colon to bulge out through the weak spots in its lining. Inactive lifestyle or lack of exercise serves as a risk factor for diverticulosis. If the stools get collected in the pouches, inflammation may set in, causing diverticulitis. Most people may not have any discomfort, but some people complain of severe cramps in the lower part of abdomen, bloating, constipation and blood in the stools.

A computed tomography (CT scan) is the most common diagnostic test used. Other tests include

• Blood test - It is done to detect infections
  
  
• Stool sample - It is done to detect bleeding in the intestinal tract
  
  
• Digital rectal exam - Your doctor will examine the rectum by passing a gloved finger to check for any bleeding or a blockage
  
  
• X- ray and barium enema
  
  
• Colonoscopy

Treatment

Diverticulosis - A diet containing lots of fiber and fluids can help reduce symptoms of diverticulosis. The American Dietetic Association recommends an intake of 20-35 grams of fiber per day. Fiber containing products such as methylcellulose (Citrucel) or psyllium (Metamucil) can be taken upto three times a day.

Diverticulitis - Your doctor will prescribe an oral antibiotic, pain reliever and advise bed rest. A liquid diet is recommended in order to rest the colon. If the symptoms of diverticulitis recur and you do not respond well to the antibiotics, your doctor may recommend surgery which involves removal of the affected part of the colon (colon resection).

Laparoscopic Colorectal Surgery

Laparoscopic colorectal surgery is a technique which involves operations on the colon and rectum through 4 or 5 small incisions. A laparoscope (a narrow tube having a tiny camera) is inserted through the incision which gives the surgeon, an enlarged image of the internal organs on a television screen.

Colorectal conditions that can be treated using laparoscopy include:

• Diverticular disease (diverticulitis)
• Appendicitis
• Rectal polyps
• Rectal cancer
• Severe constipation
• Rectal prolapse (relaxed/unsupported rectal tissue)
• Colon volvulus (twisting or displacement of the intestines)
• Inflammatory bowel disease (Crohn’s or ulcerative colitis)

Procedure

The surgical procedure is performed in a hospital under general anesthesia. Several small incisions (3 to 5) which are less than 0.5 cm are made in the abdomen. Trocar (narrow tube-like instrument) is placed through these openings. A laparoscope is inserted through one of the trocars, which gives an enlarged view of the internal organs on the television screen. The surgery is performed through the others trocars by inserting special instruments or by enlarging one of the incisions to remove part of the colon.

Preparation for Surgery

Preparation for colorectal surgery involves cleansing the colon or “bowel preparation”. Your surgeon will prescribe an enema and antibiotics following which you should not eat solid food for 8 hours before the surgery. You will be advised to discontinue your regular medications such as blood thinners, warfarin, aspirin or ibuprofen.

Post-operative Care

You can resume normal activities in one or two weeks following the surgery. You can start walking the next day of your surgery. Loose stools are normal for the first two weeks after surgery. Seek medical help if you come across following conditions:

• Watery stools for more than 3 days
• Nausea and vomiting
• Pain in your abdomen
• Pus discharge or redness around your incision
• Fever with chills (temperature of 100.5°C or higher)
• Bleeding from the rectum

Stomas

A stoma is an artificial opening of the intestine or the urinary tract in the abdomen which is created surgically to collect wastes (feces or urine). The common surgical procedures that produce stoma are colostomy, ileostomy and urostomy.

• Ileostomy - In this procedure, opening is made from the small bowel and the stoma is made to allow faeces to leave your body by-passing the large bowel.
  
  
• Colostomy - In colostomy, opening is made from the large bowel so that faeces leaves the body without passing through the anus.
  
  
• Urostomy - In this procedure, opening is made from the ureters and urine leaves the body without reaching the bladder.

The stoma can be either temporary (reversed later) or permanent, depending on the type of operation performed and the amount of bowel or urinary tract that has been removed. There are three different types of stomas which include end stomas, loop stomas, continent stomas.

• End Stomas - These are simpler to create. The cut end of the bowel is brought through the abdominal wall and fused to the skin.
  
  
• Loop stomas - These are temporary and are created when a mobile loop of the bowel is brought through the abdominal wall and attached to the skin.
  
  
• Continent stomas - These are used to create valve-like mechanism in the bowel near the skin opening which will allow discharge of feces only during intubation.

Stoma Care

You can return to your normal daily activities after full recovery from your stoma operation. You should wear a proper support, if your work involves lifting heavy objects and strenuous exercises.

• Diet - Your surgeon will advise you to avoid foods which may produce wind such as beans, broccoli and cabbage. A diet rich in fibrous foods is recommended to avoid constipation.
  
  
• Skin care - Various protective pastes, membranes and powders are available to protect the skin around the stoma.