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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.
After, and when it goes wrong
Post-op & Emergencies
The expected course, the ward reads, and the calls that cannot wait.
The expected course and the ward reads, then the complications and the calls that cannot wait.
On the ward
Three boards, three reads
POD 5 · anterior resection
New AF at 128
CRP 240 from 150
Temp 37.9
Abdomen mildly tender
Ileostomy active
What is this board really showing?
The read
An anastomotic leak until proven otherwise: new atrial fibrillation at day five after a colorectal join is the classic herald, and the rising CRP seconds it. The move is a septic screen and a CT with contrast today, the surgical team told directly, and rate control treated as a parallel task rather than the answer.
POD 6 · loop ileostomy
Stoma output 2.1 L/24h, watery
Creatinine 140 from 80
Na+ 129
Thirsty, dizzy standing
More oral water and home tomorrow?
The read
The opposite: this is a high-output stoma dehydrating its owner, and hypotonic fluid makes the sodium and the output worse. Measure and replace losses intravenously, restrict hypotonic oral fluids, start loperamide before meals and consider omeprazole, hunt a cause (infection, obstruction, medication), and involve the stoma team. Discharge waits until the output is tamed and the kidneys recover.
POD 1 · end colostomy after Hartmann's
Stoma dusky purple at the mucosa
Abdomen soft
Obs stable
Good urine output
How bad is dusky?
The read
It depends on depth, and a test tube and a light settle it: mucosal congestion above the fascia is common and usually declares itself viable over days, while ischaemia extending below the fascia is a return to theatre. Document with the tube test, mark the level, review serially, and escalate rather than reassure if the darkness descends.
Emergencies
The calls that cannot wait
Perforated diverticulitis
Recognise: Left iliac fossa pain becoming generalised peritonitis, fever, and free gas on imaging: the pocket has burst.
First move: Resuscitate, antibiotics, and the theatre conversation now: purulent or faeculent peritonitis is a laparotomy, and the stoma counselling happens before the anaesthetic room.
The closed loop: obstructing cancer with a competent valve
Recognise: Large bowel obstruction with a caecum stretching past 10 cm or becoming tender: the thinnest wall is announcing it will fail first.
First move: This is the large bowel obstruction that cannot wait for morning: resuscitate fast and move to definitive management, resection, stoma or stent, before the caecum makes the decision.
Fulminant colitis & toxic dilatation
Recognise: A severe colitis patient with a rising heart rate, a dilating colon on the film, and an abdomen becoming quiet and distended, with steroids muffling the signs.
First move: Surgical review today, films daily or more, and a low threshold for subtotal colectomy: perforation of a toxic colon multiplies mortality several-fold.
Necrotising perineal infection
Recognise: Perianal pain out of proportion, spreading induration, dusky skin or crepitus, and a patient sicker than the surface suggests.
First move: This is Fournier's territory: broad antibiotics and radical debridement in theatre within hours, with the first operation rarely the last.
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.