The answer
The image shows the entire colon which has been excised from the patient. This
is a total or pan colectomy. There is little mesentery and terminal ileum in the
specimen because no attempt has been made to do a lymph-adenectomy as might be
required in the case of colectomy for cancer.
The reconstructive options are;
- Primary ileo-rectal anastomosis.
- End ileostomy with subsequent ileo-rectal anastomosis
- End ileostomy with no reconstruction
What the student might say
This looks like a total colectomy. It would be possible to do an ileo-rectal
anastomosis or to oversew the rectum and bring out the ileum as an end stoma.
Given the patients condition it may be safer to bring out a stoma. This must be
balanced against the added morbidity of subsequent surgery with attempted
reversal.
Small Print
This is not a pan-procto-colectomy because there is no rectum in the
specimen.
A pan colectomy is the same thing as a total colectomy, all of the colon
is removed.
If the patient had a radical colectomy with lymph-adenectomy one would see
the attached mesentery with its blood vessels and lymph nodes. Lymph-adenectomy
is advocated in operations for cancer to treat and stage the disease. It is not
necessary if the operation is for a non-malignant condition.
This is not a left hemi-colectomy because the right colon is attached.
An extended right hemi-colectomy would leave part of the descending colon
and all of the sigmoid colon. It is used for cancers of the transverse colon
and splenic flexure.
