Diseases of the Colon (Gastroenterology and Hepatology)

840 Pages·2006·16.33 MB·English

by  Steven D. Wexner

Diseases of
the Colon
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Gastroenterology and Hepatology
Executive Editor
J. Thomas LaMont, M.D.
Chief, Division of Gastroenterology
Beth Israel Hospital
Boston, Massachusetts
and
Charlotte F. and Irving W. Rabb Professor of Medicine
Harvard Medical School
Boston, Massachusetts
1. Crohn’s Disease, edited by Cosimo Prantera and Burton I. Korelitz
2. Clinical Gastroenterology in the Elderly, edited by Alvin M. Gelb
3. Biliary and Pancreatic Ductal Epithelia: Pathobiology
and Patho-physiology, edited by Alphonse E. Sirica
and Daniel S. Longnecker
4. Viral Hepatitis: Diagnosis • Treatment • Prevention, edited by
Richard A. Willson
5. Gastrointestinal Infections: Diagnosis and Management, edited by
J. Thomas LaMont
6. Gastroesophageal Reflux Disease, edited by Roy C. Orlando
7. Gallbladder and Biliary Tract Diseases, edited by Nezam H. Afdhal
8. Management of Chronic Viral Hepatitis, edited by Stuart C. Gordon
9. Diseases of the Colon, edited by Steven D. Wexner and Neil Stollman
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Diseases of
the Colon
edited by
Steven D. Wexner
Cleveland Clinic Florida
Weston, Florida, U.S.A.
Neil Stollman
University of California–San Francisco
San Francisco, California, U.S.A.
New York London
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Library of Congress Cataloging‑in‑Publication Data
Diseases of the colon / edited by Steven D. Wexner, Neil Stollman.
p. ; cm. ‑‑ (Gastroenterology and hepatology ; 9)
Includes bibliographical references and index.
ISBN‑13: 978‑0‑8247‑2999‑8 (hardcover : alk. paper)
ISBN‑10: 0‑8247‑2999‑4 (hardcover : alk. paper)
1. Colon (Anatomy)‑‑Diseases. 2. Rectum‑‑Diseases. I. Wexner, Steven D. II. Stollman, Neil. III.
Series: Gastroenterology and hepatology (New York, N.Y.) ; 9.
[DNLM: 1. Colonic Diseases. WI 520 D6105 2006]
RC803.D57 2006
616.3’4‑‑dc22 2006046564
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This book is dedicated to two groups of people.
First, to my family: my loving wife, Nicolette, and my children, Wesley, Marisa, Trevor,
and Gabriella. Their love motivates me to succeed in projects such as this one. As
always, it is valuable time away from them that allows my academic activities to flourish.
I thank them and I love them very much for their support, understanding, and
encouragement.
Second, to two of Cleveland Clinic Florida’s major philanthropic supporters: Mr. Nick Caporella and
Dr. Daniel Dosoretz. Their vision, philanthropy, and altruism has allowed me to pursue my quest for
continued growth and development in my specialty. Many other friends, supporters, and grateful
patients have followed the lead of these two gentlemen and recognized the need for generous gifts to
Cleveland Clinic Florida to allow me to continue to research and to publish. The culmination of those
efforts is reflected in, in part, the production of this book.
Steven D. Wexner, M.D.
I am fortunate to have received guidance from many mentors throughout my career, for
which I am grateful, but none has been as kind, supportive, and ultimately formative than
Arvey Rogers, M.D., who has fostered my curiosity, my intellect, my skills, and, above all,
my compassion. I remain deeply appreciative and thankful. Equally, I wish to thank my
wonderful family, Lisa, Benjamin, and Natalie, who has indulged my efforts with support
and tolerated my absences with grace.
Neil Stollman, M.D.

Preface
Some specialties, such as psychiatry, are mainly solitary endeavors where a physician and a
patientmayworktogether.Otherspecialties,suchasprimarycare,functionasacentralhub,
surroundedbyvariousspecialistswhocanconsultasneeded.Incontrast,diseasesofthecolon
require an in-depth collaboration between gastroenterologists and colorectal surgeons.
Inconsideringthisendeavoratitsinception,wenotedthattherewerenumerousbooks
on general gastroenterology, usually authored, naturally, by gastroenterologists; likewise,
numeroustextsoncolonicsurgeryhavebeenauthoredbysurgeons.Wesoughttocloselyinte-
gratethesetwoalliedspecialties. Granted,somegastroenterology textbooksincludechapters
writtenbysurgeonsandviceversa.However,thesebooksdidnotseemtobefusionsbetween
the disciplines. Therefore, we designed a book that would require intimate cooperation in
writing each chapter, which certainly mirrors the interdisciplinary relationships practiced
every day by our two specialties. This methodology ensures that the reader will acquire a
significant fundofknowledge fromthe allied specialty.Surgeons willlearnhowgastroenter-
ologistsapproachaproblemandviceversa.Theirinsightswillbeinvaluableandwillimprove
the efficiency of their approach to these disorders.
Tofulfillthisgoal,wehaveprovidedacurrentcompendiumofmostmajorcolonicdis-
orders, and in almost all cases, have required that the chapter be coauthored by at least one
surgeon and one gastroenterologist. In doing so, this unique mixture hopefully highlights
the often-differing emphasis that our two skill sets bring to the care of our patients. Our
aim was to provide a useful, definitive, and concise reference source for internists, gastroen-
terologists, and general and colorectal surgeons, as well as residents and fellows in these
disciplines. From this publication the reader will learn all facets of both the medical and
surgical management of the entire gamut of disorders of the colon.
Wehavebeenextremelyfortunateinhavingmanyoftheworld’sexpertsintheirrespec-
tive areas agree to participate, and we are grateful to them. In fact, a number of our authors
havecommentedtousthatbeing‘‘forced’’toapproachtheirtopicwitha(oftennew)coauthor
from the sister discipline was quite enlightening, and brought them new insights into their
respective topics. We know our readers will share these insights and find that having both
viewpoints simultaneously presented will provide a well-balanced and ultimately useful
guidetothecareofthesepatients.Thesepresentationswillallowthereaderstoappropriately
adjust their practice to the interdisciplinary levels discussed in these chapters.
In addition to the number of experts, the editors are very indebted to Ms. Elektra
McDermott, who has shepherded this project ably, tirelessly, and wisely from inception to
completion. Equally, we thank Sandra Beberman at Informa Healthcare, who saw the value
in this collaborative effort early on and has championed it throughout.
This work will be a usefultool forourfellow practitioners, who strive daily to provide
exceptional care to their patients with colonic disorders, and to the patients who we humbly
and gratefully serve.
Steven D. Wexner
Neil Stollman

Contents
Preface . . . . v
Contributors . . . . xv
PartI. COLONIC DEVELOPMENT
1. Colonic Development, Embryology,Structure,andFunction 1
J.Marcio N. Jorge
Introduction . . . . 1
Embryology . . . . 1
Colon . . . . 2
Rectum . . . . 4
References . . . . 18
PartII. DISORDERS OFFUNCTION
2. Colonic andRectal Obstruction 23
Jorge Marcet,H. JuergenNord, and OritKaidar-Person
Introduction . . . . 23
Etiology . . . . 23
Pathophysiology . . . . 24
ClinicalPresentation . . . . 24
Evaluation . . . . 25
Treatment . . . . 26
TreatmentofSpecificCausesofColorectalObstruction . . . . 30
References . . . . 34
3. Incontinence 37
LuciaOliveira and JulioStudart de Moraes
Introduction . . . . 37
ClinicalEvaluation . . . . 37
InvestigationalMethods . . . . 41
ConservativeTreatment . . . . 48
SurgicalTreatment . . . . 54
RepeatSphincterRepair . . . . 58
SurgicalProcedures . . . . 59
Conclusion . . . . 71
References . . . . 71
4. Rectal Prolapse 81
KelliBullard Dunnand Robert D. Madoff
History . . . . 81
AnatomyandPathophysiology . . . . 81
Epidemiology . . . . 81
Presentation . . . . 82
Evaluation . . . . 82
Treatment . . . . 83
AbdominalProcedures . . . . 83
PerinealProcedures . . . . 86
LaparoscopicProcedures . . . . 86
TreatmentofIncarceratedRectalProlapse . . . . 88
RectalProlapseinChildren . . . . 89
RectalProlapseinMen . . . . 89