Inferior Mesenteric Artery
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Inferior Mesenteric Artery
Malignancy- A 64-year-old man recently underwent low anterior resection for stage III adenocarcinoma (T3, N1) of the mid-rectum after neoadjuvant chemoradiotherapy. He reports mild urinary incontinence and that he can achieve an erection and orgasm but does not ejaculate. Injury to which nerve structures is the most likely cause of his symptoms?
- You are counseling a 48-year-old man on laparoscopic low anterior resection for T2N0 rectal cancer, as shown on magnetic resonance imaging (MRI). He asks about possible risks of surgery. Which of the following nerves can be injured during high ligation of the inferior mesenteric artery (IMA)?
Malignancy- A 64-year-old man with a midrectal cancer undergoes neoadjuvant therapy and subsequent total mesorectal excision with anastomosis. After surgery, he complains of urge urinary incontinence and retrograde ejaculation. Which of the following aspects of the operative procedure are responsible for his postoperative symptoms?
- An obese 55-year-old man underwent proctectomy with coloanal anastomosis for a distal locally advanced rectal tumor. He developed impotence and urinary retention after surgery. At which point in the dissection did this injury likely occur?
- A 65-year-old man undergoes low anterior resection for an anterior rectal cancer requiring excision of Denonvilliers fascia as a component of the surgical margin. He develops erectile dysfunction postoperatively. Which nerves were most likely to have been damaged during the course of dissection?
- A 55-year-old man undergoes low anterior resection with primary anastomosis for a T2N0 rectal cancer located 9 cm from the anal verge. The splenic flexure was mobilized, the inferior mesenteric artery was divided distal to the take-off of the left colic artery, followed by total mesorectal excision. His recovery is uneventful. He returns to the clinic 3 months after surgery describing normal erections, but he is unable to ejaculate. At which step of the operation is nerve damage most likely to have occurred?
- Benign Disease
- Laparoscopic left colectomy was performed for a 4-cm adenocarcinoma found at the mid-descending colon. A tension-free colorectal anastomosis was performed using the distal transverse colon at the splenic flexure as the proximal conduit. On postoperative day 4, an anastomotic leak was seen on computed tomography (CT). What is the most likely reason for failure of this anastomosis?
- A 34-year-old woman undergoes total abdominal colectomy with an ileostomy for fulminant ulcerative colitis. She strongly desires to avoid a permanent stoma. She is counseled extensively regarding J pouch and she chooses to undergo completion proctectomy. After constructing a J-pouch, you find that the apex of the pouch does not reach the divided rectal cuff. Which is the most appropriate next step?
- A 56-year-old patient with a BMI of 41 is transferred to your hospital after undergoing emergent sigmoid colectomy with colostomy for perforated diverticulitis. On postoperative day 3 she is found to have sloughed the distal portion of the ostomy due to necrosis and retraction of the stoma (see figure below). Bedside evaluation demonstrates ischemia that extends proximal to the fascia. The patient is currently hemodynamically stable. Computed tomography angiogram of the abdomen and pelvis demonstrates patency of the celiac and superior mesenteric arteries and no visualization of the the inferior mesenteric artery. What is the best next step in management?
Anatomy and Embryology of the Colon, Rectum, and Anus- Perioperative
- Anorectal Disease
- Colorectal Cancer: Minimally Invasive Surgery
- Inferior Mesenteric Vein
- Minimally Invasive Complete Mesocolic Excision with Extended Lymphadenectomy for Colon Cancer
- Anastomotic Construction
- Anorectal Disease
- A patient undergoing anal manometry is asked to perform a squeeze maneuver. The neural innervation for the maneuver originates from
- A 51-year-old man is undergoing a screening colonoscopy during which a partially circumferential mass at the level of the upper rectal valve is found. On rigid proctoscopy, the mass is found to be located 11 cm from the anal verge. On pathologic evaluation, the lesion is identified as a moderately differentiated invasive adenocarcinoma. Pelvic magnetic resonance imaging (MRI) with and without contrast showed a T3N1 mass without extramural venous invasion (EMVI) and a radial margin of 7 mm. What is the immediate lymphatic drainage of the lesion?
- A 56-year-old patient is diagnosed with rectal cancer just above the dentate line. What is the lymphatic drainage of this lesion?
Laparoscopic Low Anterior Resection- Rectal Anatomy
- Colon Cancer Surgical Treatment: Principles of Colectomy
- Colonic Diverticular Disease
- Proctectomy for Rectal Cancer
- Standardized Operative Report
- Benign Disease
- A 37-year-old man with a history of ulcerative colitis develops toxic megacolon. Which maneuver is recommended at the time of emergent total colectomy with ileostomy to increase the likelihood of success of a future ileoanal pouch creation?
- A 72-year-old woman is admitted to the medical intensive care unit with congestive heart failure and hypotension. You are consulted for sudden onset of crampy abdominal pain and bloody diarrhea. On examination, she has mild abdominal tenderness. What is the best initial step in management?
- You are asked to evaluate a 63-year-old woman with rectal bleeding 2 days after she underwent endovascular abdominal aortic aneurysm repair. What is your next best diagnostic step?
- Open Left Hemicolectomy for Proximal Sigmoid Cancer
- Robotic Abdominoperineal Excision with Lateral Pelvic Lymph Node Dissection
Late Anastomotic Leakage After Rectal Cancer Surgery: Incidence and Differential Risk Factors- Surgical Techniques for Length
- Colonic Physiology
- Medial-to-Lateral Approach to the Laparoscopic Low Anterior Resection
- Splenic Flexure Mobilization
- V-Y Gluteal Fasciocutaneous Advancement Flap after Robotic Abdominoperineal Resection
- Colorectal Cancer: Management of Distant Metastases
- Bowel Transection and Anastomosis
- Laparoscopic Rectosigmoidectomy with Transvaginal Specimen Extraction for Intestinal Endometriosis
- Urinary Complications
- Radiation, Microscopic, and Ischemic Colitis
- Male Genitourinary Dysfunction as a Consequence of Colorectal Surgery
- Perioperative
- A 55-year-old woman undergoes a sigmoid colectomy with primary anastomosis. Which factor increases the risk for an anastomotic leak?
- While performing a low-anterior resection for rectal cancer, you identify a transection of the left ureter in the region of the lateral rectal ligament. What is the best method to repair this injury?
- Robotic Low Anterior Resection
- Sexual Dysfunction and Its Management
- Sexual Function After Colorectal Surgery in Women
- Technique of Total Mesorectal Excision
- General Postoperative Complications
- Treatment of Left-Sided Colonic Diverticulitis (2020)
- Management of Colon Cancer (2022)
- Hemorrhoids
- Management of Rectal Cancer (2020)
- Anastomotic Complications