1. Morag Sime and Chloe Hymers
Colorectal Surgery!!
Morag Sime and Chloe Hymers

2. Aims Understand hernias- including types and complications
Know main causes of bowel obstruction, the diagnosis and initial management
Recognise stomas- colostomy vs ileostomy

3. Objectives (from your syllabus)
Recognise the possibility of bowel obstruction
Initiate appropriate investigations and management
Understand anatomical factors that produce a potential defect at common hernia sites
Recognise common ways in which hernia present
Detect hernias in ant abdominal wall, inguinal and femoral region
Recognise common complications of hernias

4. Hernias Definition of a hernia:
A hernia is the protrusion of a viscus or part of a viscus outside the cavity which normally contains it.

5. Types of hernia

6. Examining a hernia
What are you looking for?

7. Complications of hernias
Compromised bowel transit
Incarcerated
Compromised blood supply
Obstructed
Irreducible
Strangulated

8. Complications of complications
Perfortation
Peritonitis
Death

9. Management Conservative: Medical Surgical Reassurance Watch and wait
Truss
Treat cause (eg??)
Medical
Surgical
Mesh repair
+/- Bowel resection

10. Bowel Obstruction

11. Main Causes
How to classify?
Intraluminal
Intramural
Extraluminal

12. Main Causes Intraluminal Intramural Extraluminal Faecal impaction
Gallstone Ileus
Intramural
Cancer
Diverticular strictures
IBD strictures
Extraluminal
Adhesions
Hernias
Volvulus
Other cancers

13. Management of bowel obstruction
DRIP AND SUCK
IV fluids
NG tube
Bloods
CXR, AXR ?CT
Catheter
Analgesia (IV)
NBM
Antiemetics PR

14. Stomas

15. Case Study
A 72 year old man presents with a painful swelling in his right groin. He explains that he has ‘had a lump’ there for years and it’s never given him any trouble before. On examination he has a 4cm tender mass which is not reducible. The skin overlying is dusky coloured. It is located medially and inferior to the pubic tubercle.

16. Questions What are the differentials?
What investigations would you do?
What is the initial management?
Explain having a CT scanner to the patient
Explain post op care to the patient

17. Most important things to know for finals…
1) Definition of a hernia
2) Anatomy of the inguinal canal
3) Most common causes of bowel obstruction

18. Most important things to know for life….
1) Is it a dangerous hernia??
2) Initial management of bowel obstruction
3) Always do a PR

19. Any Questions????