Gross presentation –bowel loop
Anatomy Large bowel
• Forms three sided frame around SI leaving inferior area open to the pelvis.
• Approx. 1.5 m in length & extend from lleum to anus.
• Diameter dec from caecum (7cm) to sigmoid colon (2.5cm).
• Divided into 4 segments-cecum,colon,rectum & anus.
Types of bowel resection
• Total colectomy.• Right hemicolectomy.• Transverse colectomy. • Left hemicolectomy.• Low anterior resection.• Abdominoperineal resection.
Procedure
• Weigh & measure the specimen• Sample lymph nodes, & remove the mesentry
while the specimen is fresh.• Two options are there:-
A) Open the bowel longitudinally, pin on a corkboard & fix it overnight.
B)Injecting formalin through one end when the other end is tied, then tying off the injected end.
• Take photographs .• In cases with deep penetration by tumor,
dissect the veins carefully for possible tumor invasion.
Description • Part of bowel removed & length of specimen .• Mucosa- type of lesion,extent,ulceration(linear or
transverse),depth, pseudoplyps,hemorrhage,fissures.• Wall thickening (focal or diffuse),atrophy ,fibrosis,
necrosis.• Serosa- fibrin, pus,fibrosis,adherence of mesentry.• Diverticulum- number, size, location in relation to
teniae,content, evidence of inflammation, hemorrhage or perforation.
Description for tumor
Tumor • size (including thickness).• Shape (fungating,flat,ulcerating)• Extent through bowel wall• Serosal involvement,satellite nodules.• Areas of necrosis & hemorrhage.• Evidence of blood vessel invasion & invasion of
adjacent organs.
• Distance of tumor to each line of resection. • Estimate the no. of lymph nodes found,
whether or not nodes appear to be involved by tumor, size of largest node.
Sections for histology
For non tumoral conditions:-• As many as necessary to sample abnormal areas.• Proximal & distal lines of resection in cases of colitis.• Appendix, if included in specimen.
For tumoral conditions:-• 3 sections from tumor.• Representative section of subserosal connective
tissue, fat & blood vessel around tumor.• Both surgical margins.• Bowel b/w tm & distal line of resection.
• Appendix if included in the specimen.
• Lymph nodes:-
A) around tumor.
B)distal to tumor.
C)proximal to tumor.
D)at high point of resection(areas surrounding ligated vessels)
• In abdominoperineal resections:- anorectal junction.
Meckels diverticulum
Crohns disease
Ulcerative colitis Pseudo polyps
Tuberculosis Typhoid
Mesentric embolism Carcinoid tumor
Diverticular disease Diverticulitis
Chronic ischaemic colitis
Pseudomembranous colitis
Amebic dysentery
Tubular adenoma
Villous adenoma
Familial polyposis coli
MELANOSIS COLI
Endometriosis
Ulcerating rectal carcinoma
Fungating rectal carcinoma
Annular stenosing rectal carcinoma
Caecal carcinoma
Hirschsprung disease
SPEAKER DR N. P. TIWARITHANK YOU