Diseases of the colon and rectum
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Purulent or fecal peritonitis is one of the most serious complications of acute diverticulitis. Up to one-fourth of patients hospitalized for acute diverticulitis require an emergent operation for a complication, including abscess, peritonitis, or stenosis. Open Hartmann's procedure has been the operation of choice for these patients. The advantages of laparoscopy could be combined with those of the primary resection in selected patients with peritonitis complicating acute diverticulitis. However, because of technical difficulties and the theoretic risk of poorly controlled sepsis, laparoscopic Hartmann's procedure has been seldom reported for such patients. ⋯ The results of this small series demonstrated that the indications of laparoscopy in diverticulitis could be extrapolated to selected patients with peritonitis. The technical feasibility and safety of laparoscopic Hartmann's procedure in selected patients seem acceptable. However, larger-scale, controlled studies are needed to define more accurately the role of laparoscopy in complicated diverticulitis.
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Iron deficiency anemia can be the first presentation of right-sided colon cancer. There is an impression that because this presentation is nonspecific it may be associated with a longer delay from referral to diagnosis compared with those patients with symptoms of change in bowel habit and/or rectal bleeding caused by more distal colorectal cancer. This study was designed to determine the incidence of colon cancers in patients referred to the hospital with iron deficiency anemia and to determine what proportion of these patients were referred and diagnosed urgently in line with cancer waiting time targets. ⋯ Males referred with iron deficiency anemia have a significant risk of having colon cancer. The risk seems lower in females; this gender difference has been observed in other studies and further evidence should be sought before advising any change in referral practice.
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Currently, surgeons specialize in colon and rectal surgery after a complete residency and certification in general surgery. The American Board of Surgery is proposing reorganization of surgical training; only two to four years of general surgery would be required followed by two to three years of specialization. The general surgery practice patterns of colon and rectal surgeons are unknown. ⋯ Currently, colon and rectal surgeons perform general surgery procedures in clinical practice. If general surgery residency of future trainees is shortened, the types of procedures colon and rectal surgeons will be competent to perform may need to be redefined. This will have profound implications on training programs, certification requirements, and future practice patterns.