The colon are diverticula usual location

95% of all diverticula occur in the left colon, primarily in the sigmoid colon. Diverticula, however, may occur anywhere in the colon. In Asia, right colonic diverticula are also common.

Most common age for diverticulitis to occur….

The sixth or seventh decade of life. Patients younger than 50 with diverticulitis tend to have more complications. Younger patients are more likely than older patients to have right colonic diverticulitis.

The strategy to decrease diverticulitis in patients with diverticula’’’

A diet high in fiber. Large bulk in the colon decreases segmentation and intraluminal pressure.

Diagnosing acute diverticulitis

Computed tomography (CT) scan, which can also diagnose local complications of diverticulitis.

Complications occur as result of perforation of a colonic diverticulum

• Inflammatory phlegmon or abscess in the bowel mesentery
• Peritonitis
• Intra-abdominal abscess
• Internal fistula
• Bowel obstruction

Can diverticular disease cause bleeding?

Yes. Diverticulosis (not-itis) is a common cause of lower gastrointestinal bleeding. Bleeding from diverticulitis is uncommon.

Procedures may be used when perforation of the diverticulum results in an abscess

• Diverting colostomy and abscess drainage (first of three stages)
• Resection of involved colon with proximal colostomy and distal mucous fistula or closure by Hartmann's operation (first of two stages)
• Resection with primary anastomosis (one stage)

Other complications of diverticular disease are a vesicocolic or ureterocolic fistula usually occurs after diverticular perforation

A staged procedure was the standard until recently. Now most patients can be treated with a single procedure that includes sigmoid resection, colonic anastomosis, and primary repair of bladder defect with absorbable suture. A Foley catheter is usually left in place for 10 days after surgery. Some viable tissue should be placed between the colonic and bladder repairs to prevent a recurrent fistula.

Colonic ischemia

Coloinic trauma

Colonic fistulas

Incidence of colo rectal cancer in INDIA

Lung, breast or prostate, and colon cancer.

List offew of the presenting symptoms of patients with colorectal cancer. Intermittent rectal bleeding, vague abdominal pain, fatigue secondary to anemia, change in bowel habits, constipation, tenesmus, and perineal pain.

Basic investigation to evaluate a patient with above symptoms.

To evaluate the entire colon and rectum, one may perform stool foe occult blood and proctoscopy/ a colonoscopy. Colonoscopy is most sensitiveand can detect lesions < 1 cm.

List of most common five risk factors for colorectal cancer.

Prior adenomatous polyps, family history of colorectal cancer, age older than 40 years, chronic ulcerative colitis, Crohn's colitis, history of colon cancer, exposure to pelvic radiation for prostate or cervical cancer, and familial polyposis. Hamartomatous polyps (Peutz-Jeghers syndrome), inflammatory polyps, and hyperplastic polyps are not considered premalignant.

Treatment options for colorectal cancer are dependent on the tumor location.

Colonic cancers are more commonly treated with surgical therapy first followed by depends on final biopsy results adjuvant chemotherapy is required

Rectal cancer is now more commonly managed with neo adjuvant therapy followed by surgical therapy.

KEY POINTS: COLORECTAL CARCINOMAM

• Presenting symptoms may include intermittent rectal bleeding, vague abdominal pain, fatigue secondary to anemia, change in bowel habits, constipation, tenesmus, and perineal pain.
• Treatment options for colorectal cancer are dependent on the tumor location.
• Patients with lymph node involvement should receive chemotherapy postoperatively to treat micrometastases.

Which patients with colorectal cancer require adjuvant (postoperative) therapy?

Patients with lymph node involvement should receive chemotherapy postoperatively to treat micrometastases. Two large studies have documented a survival advantage for these patients.

Patients with rectal cancer with a significant chance of local recurrence should be treated with radiation therapy. This may be given preoperatively, postoperatively, or with a combined "sandwich" technique.

Colonic NET/ GIST tumors