Preoperative Examination

There is perhaps no other disease in which the teamwork between the surgeon and the gastroenterologist is so important. Thus, the first step in preoperative examination is to understand the gastroenterologist's opinion regarding the state of the patient's disease. This, of course, is most effective through direct communication.

Radiology

Preoperative radiology examination has taken on additional importance with the advent of minimally invasive surgical approaches to CD. Since the surgeon's fingers may not be feeling all aspects of the bowel, knowledge regarding the portions of bowel that are likely to be diseased is particularly important.

The mainstay of preoperative examination is the contrast gastrointestinal (GI) radiograph. Most commonly this is an upper GI and SB follow-through study. Even in patients with CD limited to the colon, the SB should be studied to avoid surprises in the operating room. Consultation with the radiologist performing the study will arm the surgeon with nuances regarding the disease and the anatomy that are not obtainable from the written radiology reports. Computed tomography (CT) scanning complements the luminal study, because it provides information regarding thickening of the bowel wall and the mesentery. This is particularly true with the current ability to synthesize three-dimensional imaging from CT scan data. CT scans also provide important information regarding the possible involvement of other organs by fistulizing CD. For instance, a CT revealing a dilated ureter on the right hand side likely means that local inflammation has created a partial ureteral obstruction. This would be an important preoperative warning that dissection in this region will be dangerous, and that placement of ureteral stents should be planned.

Colonoscopy

All patients undergoing abdominal surgery for CD should have the colon examined, preferably via colonoscopy in the recent past, even if no colonic involvement is suspected. In general, visual inspection of the outer colonic wall at surgery will not necessarily reflect CD within the lumen. Early mucosal CD in the colon can look quite normal from the outside. For patients anticipating surgery with known involvement of the colon, colonoscopy is particularly important to map out the diseased and nondiseased sege-ments, and to plan the appropriate procedure.

For most patients, a SB series, CT scanning, and colonoscopy will suffice. However, additional studies to answer specific questions can be very helpful. For instance, a white blood cell tagged scan can assess the degree of active inflammation in tissues affected by CD. Magnetic resonance imaging has also been reported to be helpful in this regard, but in our experience does not add significantly to the data that good CT scanning (sometimes with water for contrast rather than normal contrast agent) provides. If the patient has symptoms referable to the upper GI tract, this should be evaluated by endoscopy. The duodenum can be afflicted with primary CD involvement, or it can suffer involvement by proximity to a diseased hepatic flexure of the colon, or even an adjacent loop of diseased SB.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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