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SurgSpace / Specialties / Colorectal Surgery
Colorectal Surgery
Colon, rectum and anus: cancer resections planned on embryological planes, inflammatory bowel disease, diverticular disease and its perforations, and the stomas that make radical surgery survivable. The specialty where anatomy, oncology and function meet most visibly.
Apply it
Cases & Practice
Patients to decide on, images to interpret, and the first day on the rotation.
Patients to decide on, images to interpret, and the briefing for the first day on the rotation.
Decisions, one patient at a time
Cases
Imaging practice
Read the image, then decide
Surgical decision-making
Does this patient need surgery?
Perforated sigmoid diverticulitis with purulent peritonitis in a 62-year-old, stable after resuscitation. Resect and join, or resect and bring out an end colostomy?
Hartmann's procedure
Resection, oversewn rectal stump, end colostomy: no anastomosis to leak in a contaminated abdomen. The price is a second operation to reverse it, which a third of patients never have.
Primary anastomosis (± defunctioning stoma)
One-stage restoration in the stable patient with limited contamination, often protected by a loop ileostomy: a leak risk accepted to avoid the Hartmann's reversal mountain.
The decision weighs tonight's leak risk against next year's reversal: contamination, stability, steroids and nutrition push toward Hartmann's; a stable patient and a clean-enough field make primary anastomosis with protection defensible. The stoma counselling happens before the anaesthetic, whichever way it goes.
A low anterior resection with a join 4 cm from the verge, after radiotherapy. Protect the anastomosis with a loop ileostomy?
Defunctioning ileostomy
Diverts the stream while the join heals: it does not prevent leaks, it defangs them, converting an abdominal catastrophe into a contained problem.
No stoma
Spares the second operation and the stoma months for high, well-perfused, untreated-field joins in fit patients: a calculated exposure.
Low joins, irradiated fields, difficult operations and frail patients earn protection: the ileostomy is an insurance policy paid in months of stoma care and a closure operation. Saying 'the stoma does not stop the leak, it changes what the leak means' is the counselling in one sentence.
Day 3 of intravenous steroids for acute severe colitis: eight bloody stools, CRP 90, albumin 24. Rescue therapy or colectomy?
Medical rescue
Infliximab or ciclosporin for the partial responder, with a defined reassessment window measured in days and the surgical team still in the room.
Subtotal colectomy
For the non-responder or deteriorating patient: remove the burning colon, end ileostomy, reconstruction later. Done in time it is a safe operation; done late it is a salvage.
The mortality of acute severe colitis lives in delayed surgery, not early surgery: the day-3 review is a real fork, the surgeon should have met the patient before the decision is forced, and 'one more day of steroids' repeated daily is how colons perforate.
The rotation
Your first day here
- Read the embryological planes module before your first cancer resection: the operation is incomprehensible as tissue and obvious as embryology.
- Look at every rectal MRI with the report in hand: the mesorectal margin is the sentence that decides the whole treatment sequence.
- On the ward, new atrial fibrillation after a bowel anastomosis means leak until proven otherwise: say it aloud and you will fit right in.
- Learn stomas early: what kind, what output, what the bag should contain. The stoma nurses are the specialty's best teachers and worth an hour of your first week.
- Per rectum examination and rigid sigmoidoscopy are the specialty's vital signs: never present a rectal bleed without them, or say honestly that they have not been done.
- In the MDT, track one patient from scan to decision: the meeting is where the specialty actually thinks.
Hub shaped by the Surgical Specialties Lead with the Colorectal surgery reviewer (open seat). Images and videos carry their source; educational use for supervised learning, not clinical guidance.