NMS. Casos Clínicos

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Chapter 8 ♦ Lower Gastrointestinal Disorders

Figure 8-26: Abdominoperineal resection for carcinoma of the rectum. A: Prior to surgery. Note tumor in rectum. B: During surgery, the sigmoid is removed and the colostomy is established. The distal bowel is dissected free to a point below the pelvic peritoneum, which is sutured over the closed end of the distal sigmoid and rectum. C: Perineal resection includes removal of the rectum and free portion of the sigmoid from below. A perineal drain is inserted. D: The final result after healing. Note the healed perineal wound and the permanent colostomy. (From Honan L. Focus on Adult Health , 2nd ed. Wolters Kluwer Health; 2018, Fig. 24-10.) Q: What stage is this tumor? A: This tumor is a stage I cancer. SAMPLE preoperatively, and the surgeon usually chooses the lower left quadrant. Placement of the patient in the lithotomy position allows both the abdominal and the pelvic dissections to be performed simultaneously. The rectum is dissected away from the surrounding tissues, attempting to avoid injury to the nerves and urinary tract. Mesenteric lymph nodes are removed with the specimen. The colon is divided at the junction of the descending colon and the sigmoid colon, and the specimen is removed. An end colostomy is performed. The perineal wound is either closed or packed with gauze. Pathology on the specimen returns as well-differentiated adenocarcinoma of the rectum with extension into the bowel wall to the level of the muscularis propria but not involving the serosa. This information is used to stage the tumor (Fig. 8-28).