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By • Дек 18th, 2010 • Category: Rectum

Distinction should be made between solitary polyps, group polyposis (3—6 closely spaced polyps) and mul­tiple (familial or diffuse) polyposis. In multiple poly­posis the polyps (there may be dozens to thousands of them) (Fig. 181.1) are spread throughout the entire mu-cosa of the rectum and colon, but their incidence is grea­ter in the left part of the bowel.

This disease is of familial character. Its hereditary transmission does not necessarily follows the Mendelian laws. Malignant change of polyps in multiple polyposis develops almost invariably.

Treatment of multiple polyposis of the rectum and dis­tal sigmoid colon consists in excision per anum of large polyps sited up to 10 cm from the anal verge and elec-trocoagulation of smaller polyps through a proctoscope. These interventions are generally undertaken to prepare the rectum for subsequent formation of an ileorectal anastomosis.

Per anum excision of large polyps is performed fol­lowing the rules given on p. 144. With smaller peduncu-lated polyps located 5 to 25 cm from the anus, electro-coagulation is used (Fig. 181,2), as described on p. 146 (see Fig. 124.1). Small polyps may be dealt with by simply touching the polyp surface with the diathermy electrode. Not more than 10 polyps should be coagulated for a session. Sessions are done once every 8 days until a sufficient area of the rectum and sigmoid has been cleared.

Radical treatment of multiple polyposis consists 01 two stage (Fig. 182,1 and 2) or one-stage removal of the entire colon with establishment of an ileorectal anasto­mosis.

Surgical treatment of multiple polyposis

Fig. 181. Surgical treatment of multiple polyposis:

1. The resected colon with a great number of polyps.

2. Electrocoagulation of multiple polyps through a proctoscope.

Fig. 182 (I and II). Schematic representation of two-stage colectomy with ileorectal anastomosis in end-to-side fashion.

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