Colonic Diseases

Colonic Obstruction

The fellow should be able to:
  • Demonstrate an understanding of the evaluation and etiology of large bowel obstruction
  • Demonstrate an understanding of the management of LBO and how it differs from SBO, including the role of surgical treatment including resection and diversion, and the role of endoscopic stenting
  • Describe the treatment of incidentally identified colonic malignancy
  • Demonstrate an understanding of the etiology of colonic volvulus
  • Describe the treatment options for cecal and sigmoid volvulus including endoscopic and surgical techniques
Resources
  • Topic Summary
  • AAST Education Module - Large Bowel Obstruction
  • Overview Articles:
  • Additional Resources:
    • Sigmoid Volvulus: Tian BWCA; Vigutto G; et al. WSES consensus guidelines on sigmoid volvulus management. World J Emerg Surg. 2023 May 15;18(1):34. 
    • Colon and rectal cancer emergencies: Pisano M; Zorcolo L; et al. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation. World J Emerg Surg. 2018 Aug 13;13:36.
    • Arezzo A, Passera R, et al. Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery: results of a systematic review and meta-analysis of randomized controlled trials. Gastrointest Endosc. 2017 Sep;86(3):416-426. 
    • Veld JV, Amelung FJ, et al. Dutch Snapshot Research Group. Comparison of Decompressing Stoma vs Stent as a Bridge to Surgery for Left-Sided Obstructive Colon Cancer. JAMA Surg. 2020 Mar 1;155(3):206-215. 
    • Tan L, Liu ZL, et al. Comparison of the prognosis of four different treatment strategies for acute left malignant colonic obstruction: a systematic review and network meta-analysis. World J Emerg Surg. 2021 Mar 18;16(1):11. 
  • East Guidelines

Colonic Diverticulitis

The fellow should be able to:
  • Demonstrate an understanding of the evaluation and etiology of colonic diverticulitis
  • Demonstrate an understanding of the medical management of colonic diveriticulitis and expected outcomes
  • Recognize the controversy of the role of antibiotics in uncomplicated diverticulitis
  • Describe the indications and options for the surgical management of diverticulitis
  • Recognize the controversy of primary anastomosis with or without diverting ostomy
  • Describe indication for primary anastomosis vs Hartmann’s procedure
Resources

Ischemic colitis

The fellow should be able to:
  • Demonstrate an understanding of the evaluation and etiology of ischemic colitis and how it differs from mesenteric ischemia
  • Demonstrate an understanding of the treatment of ischemic colitis
  • Describe the diagnostic modalities used to diagnose ischemic colitis
  • Understand the significance of ischemic colitis in patients with recent abdominal vascular surgery
Resources
  • Topic Summary
  • Overview Articles:

Clostridium difficile Colitis

he fellow should be able to:
  • Demonstrate an understanding of the evaluation and management of C diff
  • Demonstrate an understanding of the grades of severity of C diff and impact on treatment
  • Describe the role of medical, endoscopic, and surgical options for treatment
  • Understand the controversy between colectomy and loop ileostomy with colonic lavage in the treatment of fulminant C diff
Resources