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By • Дек 19th, 2010 • Category: Colon

Resection of a portion of the colon is resorted to in cases with colonic cancer, large villous tumours, inflam­matory stricture, diverticulitis of the intestinal wall, tu­berculosis of the intestinal wall, multiple polyposis, and, finally, segmental ulcerative colitis. Total colectomy is indicated in multiple (familial) polyposis, total ulcerati­ve colitis, and multiple cancer of the colon.

The size of the portion of the colon to be removed depends not only on the tumour size, but also on the state of blood supply to the intestine. A guideline for co­lonic resection is provided by the Rorte chart shown, in a slightly modified form, in Fig. 170.

It is seen from this chart that when the cecum, ascend­ing colon, hepatic flexure, or the proximal quarter of transverse colon is affected with the pathological process, subject to removal is the entire right half of the colon together with a small portion of the ileum (see the por­tion of the intestine under No. I in Fig. 170).

If the tumour is localized in the middle portion of transverse colon, this should be resected in the usual way followed by anastomosis (II).

When the tumour is located in the distal quarter of transverse colon, in the splenic flexure, or in the descen­ding colon region, the affected portion of the colon should be always resected in its entirety with establishment of an end-to-end or end-to-side anastomosis between the transverse colon and the proximal part of the sigmoid (see the portion of intestine under No. Ill in Fig. 170). Finally, if the tumour is found in the region of sigmoid colon, this should be resected, as depicted in Fig. 1/0, IV by continuous and dotted lines, followed by anastomosis.

Chart of permissible limits of colonic resection (after Korte, with Ryglck's modifications)

Fig. 170. Chart of permissible limits of colonic resection (after Korte, with Ryglck’s modifications):

I. Schematic representation of resection with the tu­mour located either in the cecum, descending colon, hepa­tic flexure, or proximal quarter of transverse colon.

II. Limits of resection in lesion of the middle portion of transverse colon.

III. Resection with the tumour located in the right quarter of transverse colon, splenic flexure, or descending colon.

IV. Resection of portions of the sigmoid colon of va­rious sizes. Schematic.

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