Gross Examination: Colectomy and Hysterectomy

Colectomy

A colectomy is a surgical procedure involving the removal of all or part of the colon, also known as the large intestine. There are several reasons why a colectomy may be performed, including:

Colon Cancer: Colectomy may be necessary to remove cancerous tumors located in the colon. The extent of the colectomy will depend on the size and location of the tumor, as well as whether the cancer has spread to nearby tissues.


Colorectal Cancer, Posted on October 20, 2016 by Andrew Rubin


Inflammatory Bowel Disease (IBD): Patients with severe cases of ulcerative colitis or Crohn's disease, two forms of inflammatory bowel disease, may require a colectomy if medical treatments are ineffective in controlling symptoms or if complications such as perforation, severe bleeding, or toxic megacolon occur.



Diverticular Disease: In some cases of diverticulitis, a condition characterized by inflamed or infected pouches (diverticula) in the colon, recurrent episodes or complications such as perforation may necessitate surgical removal of the affected portion of the colon.



Bowel Obstruction: Severe bowel obstruction, which can result from various causes such as adhesions, tumors, or strictures, may require surgical intervention, including colectomy, to relieve the obstruction and restore normal bowel function.


There are different types of colectomy procedures, including:

  • Total Colectomy: Removal of the entire colon.
  • Partial Colectomy (Segmental Colectomy): Removal of a portion of the colon, with the extent of resection depending on the specific condition being treated.
  • Hemicolectomy: Removal of one-half (either right or left) of the colon.
  • Subtotal Colectomy: Removal of most of the colon, leaving a portion of it intact.


The surgical approach for colectomy can vary and may include open surgery, laparoscopic surgery, or robotic-assisted surgery. Laparoscopic and robotic-assisted techniques are minimally invasive approaches that involve smaller incisions and typically result in shorter hospital stays and faster recovery times compared to traditional open surgery.

After a colectomy, patients may experience a temporary or permanent ostomy, where a portion of the remaining intestine is brought to the abdominal surface to create a stoma for the elimination of stool. This may be necessary if the entire colon or rectum is removed. In some cases, especially with partial colectomies, the intestines can be reconnected, allowing for the restoration of normal bowel function without the need for an ostomy.

Recovery from a colectomy varies depending on the extent of the surgery, the underlying condition, and the individual patient's health status, but it often involves a period of hospitalization followed by a gradual return to normal activities under the guidance of healthcare professionals.

Hysterectomy

Anatomical structure of uterus





Uterine Fibroids:


Fibroids are noncancerous growths that develop in the uterus. They can vary in size and number and may cause symptoms such as pelvic pain, heavy menstrual bleeding, and pressure on nearby organs. If fibroids are causing significant symptoms that do not respond to other treatments, such as medication or less invasive procedures, a hysterectomy may be recommended as a definitive treatment option. Since fibroids are located within the muscular wall of the uterus, a hysterectomy involves removing the entire uterus, which eliminates the possibility of fibroid recurrence.


The picture shows a uterus with a large number of myomas, anteriorly dissected from the bottom up to the cervix: fibroids appear well circumscribed, firm, grey-white and with a whorled cut surface


Uterine Hyperplasia:

Uterine hyperplasia is a condition characterized by an overgrowth of the cells lining the uterus. It can be classified as simple or complex, and with or without atypia (abnormal cells). In some cases, uterine hyperplasia may progress to uterine cancer, particularly if it is complex and/or atypical. Treatment options for uterine hyperplasia depend on the severity and type of hyperplasia, as well as the patient's age and reproductive goals. If hyperplasia is severe, recurrent, or associated with atypia, and if conservative treatments such as hormonal therapy or dilation and curettage (D&C) are ineffective or not suitable, a hysterectomy may be recommended to prevent the progression to cancer and provide definitive treatment.

PATHOLOGY OF ENDOMETRIAL HYPERPLASIA


In both cases, the decision to undergo a hysterectomy is usually made after careful consideration of the individual's symptoms, medical history, desire for future fertility, and potential risks and benefits of surgery. It's important for individuals to discuss their options thoroughly with their healthcare provider to make an informed decision about the most appropriate treatment approach for their specific situation.






References:

  • Haji , A. and Roon , A. (no date) Right hemicolectomy, King Edward VII’s Hospital. Available at: https://www.kingedwardvii.co.uk/services/right-hemicolectomy#:~:text=Most%20patients%20who%20hemicolectomy%20surgery,certain%20abnormalities%20of%20the%20appendix. (Accessed: 27 March 2024). 
  • Swamy, R. (2010) “Histopathological reporting of pT4 tumour stage in colorectal carcinomas: dotting the ’i’s and crossing the ’t’s,” Journal of Clinical Pathology, 63(2), pp. 110–115. Available at: https://doi.org/10.1136/jcp.2009.069658.
  • R.D. Clayton, Hysterectomy, Best Practice & Research Clinical Obstetrics & Gynaecology, Volume 20, Issue 1, 2006, Pages 73-87, ISSN 1521-6934, https://doi.org/10.1016/j.bpobgyn.2005.09.007.
  • Complications of Hysterectomy, Clarke-Pearson, Daniel L. MD; Geller, Elizabeth J. MD, Obstetrics & Gynecology 121(3):p 654-673, March 2013. DOI: 10.1097/AOG.0b013e3182841594

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