Colorectal and Anorectal Surgery
Core Concepts
Understand the evaluation of colorectal symptoms: bleeding, change in bowel habit, and anorectal pain. Key topics: colorectal cancer screening, staging, and surgical management (colectomy with adequate lymphadenectomy). Benign anorectal conditions: hemorrhoids, fissures, fistulas, and abscesses. Know the principles of stoma creation and closure.
Traps in Questions
A common trap is the management of acute hemorrhoidal thrombosis: excision if within 72 hours, otherwise conservative. Another trap is the treatment of anal fissure: first-line is medical (fiber, sitz baths, topical nitrates), surgery (lateral internal sphincterotomy) for chronic. For rectal cancer, beware of the “low anterior resection” vs. “abdominoperineal resection” decision based on sphincter involvement. Also, know that a perianal abscess requires incision and drainage; antibiotics alone are insufficient.
Worked Example
A 35-year-old woman with a painful anal fissure for 2 weeks. What is the initial management? Answer: Increase fiber and fluids, sitz baths, and topical nitroglycerin or diltiazem.
Rule of Thumb
In colorectal cancer, obtain at least 12 lymph nodes for adequate staging.