Practice Management
14 results
1 - 14
Miscellaneous- Pelvic Floor
- Anorectal Disease
- A 20-year-old male patient with a history of a previous incision and drainage of pilonidal abscess presents to the office with gluteal cleft pain and intermittent bleeding and drainage from several midline pits with no improvement with conservative management. He is a college student with a summer internship while at home and would like to address the problem before he goes back to school. What is the best recommendation for this patient at this time?
- A 27-year-old male patient presents for evaluation of new anal lesion 2 weeks after anal intercourse with a new male partner. The lesion is at the anal verge, round, ulcerated, and non-tender (see figure below). The optimal therapy for this patient is
- Colon and Rectal Surgery Educational Program (CARSEP)
- Benign Disease
- A 32-year-old man with ulcerative colitis (UC) and a body mass index (BMI) of 15 kg/m2 has been admitted for toxic megacolon to the intensive care unit for 4 days. He was treated for septic shock and was on pressors for the first 48 hours. In the past 2 days, his condition has significantly improved, and he is off vasopressors and having 5–6 bloody bowel movements daily. Patient has been kept NPO in the ICU and is now being transferred to the floor. He is afebrile and hemodynamically stable. His white blood cell count continues to improve, and he has started on enteral feeds after 10 days of NPO status. After he is started on enteral feeding, he develops double vision, disorientation, and dyspnea. Which of the following is the most likely the cause of his symptoms?
- A 22-year-old woman with medically refractory ulcerative colitis presents for consideration of total abdominal proctocolectomy with ileal pouch-anal anastomosis (IPAA). Which of the following should be part of her preoperative evaluation?
- A 24-year-old man with history of ulcerative colitis (UC) is 3 days status postemergent subtotal colectomy with end ileostomy for toxic megacolon. He has a low-grade fever of 38.0 °C, rising heart rate to the 110s, rising leukocytosis to 15 x 109, and lower pelvic pain and pressure. Computed tomography (CT) of the abdomen and pelvis demonstrates abscess with fluid and gas adjacent and superior to the rectal stump staple line. How could the chance of complication have been reduced?
- A 65-year-old woman comes to the emergency department with progressively worsening constipation and abdominal pain over the past 3 months. She had a few mild attacks of diverticulitis. Her last colonoscopy was 2 years ago after her first episode of diverticulitis, and there were no concerns for malignancy. She is afebrile with normal vital signs; her last bowel movement was 3 days ago, and she has mostly left-sided abdominal pain. Computed tomography (CT) shows no free air or active inflammation but a significantly narrowed 8 cm length of sigmoid colon with upstream dilation of the colon, suggestive of a diverticular stricture (see figures). The best treatment option is
- Malignancy
- A 47-year-old man undergoes his first screening colonoscopy. During the procedure, five polyps are removed from the right and transverse colon, with the two largest measuring 1.2 cm and 1.4 cm; on histology, they are noted to be sessile serrated polyps. What is the best next step in management?
- A healthy 65-year-old male patient is diagnosed with a moderately differentiated rectal adenocarcinoma, microsatellite stable. Staging was negative for metastatic disease. Pelvic magnetic resonance imaging (MRI) shows possible involvement of the prostate with mesorectal lymph nodes suspicious for metastasis. What is the current recommended course of treatment for this patient, given these findings?
- Perioperative
- What intraoperative fluid strategy has been shown to optimize colorectal surgical outcomes as part of enhanced recovery after surgery (ERAS) protocols?
- A 45-year-old man with history of rectal cancer found at 5 cm from the dentate line, underwent low anterior resection. Foley catheter was placed without complication at the start of the surgery. The urine output is appropriate and clear. When should the foley catheter be removed?