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Postoperative complications Postoperative complications following appendicectomy are relatively uncommon and reflect the degree of peritonitis that was present at the time of operation and intercurrent diseases that may predispose to complications. Harrith Ha...

Pseudomyxoma peritonei PMP is a rare condition typified by progressive peritoneal tumour deposits, mucinous ascites, omental cake ( 76.17 ) and ovarian involvement in females. The vast majority of cases arise as a result of perforation of a mucinous appen di...

Treatment Non-operative management There are two scenarios in which patients with acute appendi citis may be considered for non-operative treatment. Uncomplicated appendicitis While surgery remains the standard teaching, there is evidence to support a trial of...

Unexpected appendix tumour encountered at surgery An inspection of the abdominal cavity should be performed to establish the presence of metastases or PMP . The appendix should be removed, with care taken to avoid spillage of its contents, to allow a pathol...

unexpected tumour of the appendix Incidental neoplasm in appendicectomy specimen In a patient with an incidental finding of an appendix neoplasm and no current evidence of metastatic disease or PMP , subsequent treatment is dependent on the degree of cytologi...

ANATOMY OF THE LARGE INTESTINE The large intestine begins at the ileocaecal valve and extends to the anus. It is divided into the caecum, ascending colon, hepatic flexure, transverse colon with attached greater omen tum, splenic flexure, descending colon, sigmoi...

Aetiology Epidemiological studies suggest that diverticular disease is a consequence of a refined Western diet, deficient in dietary fibre. The combination of altered collagen structure with ageing, disordered motility and increased intraluminal pres sure, most...

COLITIS There are two types of colitides: IBD (discussed in Chapter 75 ) and non-IBD. The non-IBD causes can be grouped into infec - tive and non-infective causes, with infective being by far the - most common. The majority of non-IBD colitides present acutel...

COLOSTOMIES A colostomy is a planned opening made in the colon to divert faeces and flatus through the abdominal wall, where they can be collected in an external appliance. Ileostomies are discussed in Chapter 74 . Depending on the purpose for which the diversi...

Classification of contamination The degree of infection has a major impact on outcome in acute diverticulitis. Patients with inflammatory masses have a lower mortality than those with perforation (3% versus 33%). Classification systems have been developed for co...

Clinical features In mild cases, symptoms such as distension, flatulence and a sensation of heaviness in the lower abdomen may be indistinguishable from those of irritable bowel syndrome. These symptoms are thought to result from a combination of increased ...

Complications of diverticular disease The majority of patients with diverticulosis are asymptomatic but historical studies suggest that somewhere between 10% and 30% will have symptomatic complications ( Summary box 77.11 ). Johann Friedrich Meckel (the young...

Complications of stomas Stoma complications are common ( Summary box 77.16 ). The vast majority of these complications can be dealt with by a suitably experienced stoma nurse but on occasion revision surgery is needed. Stoma ischaemia is usually evident in th...

DIVERTICULAR DISEASE Diverticula (hollow outpouchings) are a common structural abnormality of the gastrointestinal tract. They can be clas sified as: /uni25CF congenital : all three coats of the bowel are present in the wall of the diverticulum (e.g. Meckel’...

ENDOMETRIOSIS This is mainly covered in Chapter 87 . It tends to be found deep in the pelvis and therefore relates more to the rectum. On the rare occasion it is found in the colon, it may be a cause of �brosis and obstruction.

Infective colitides Infective causes may be classified as bacterial, protozoal, viral and fungal. Common infections include the following. Escherichia coli E. coli is a Gram-negative bacillus transmitted via the faeco - oral route from contaminated food or wate...

Introduction No content extracted automatically.

Investigation Radiology Plain radiographs can demonstrate a pneumoperitoneum. Spiral CT has excellent sensitivity and specificity for identify ing bowel wall thickening, abscess formation and extraluminal disease and has revolutionised the assessment of compli...