Other Conditions

There are a wide variety of other colonic and small bowel diseases and conditions which the surgeons at Fairfax Colon & Rectal Surgery are frequently called upon to manage.  A few of these are mentioned below.

Small Bowel Obstruction

There are a variety of underlying causes of bowel obstruction.  The most frequent of which is obstruction due to adhesions or scarring which develops following abdominal surgery.  Any abdominal or pelvic operation can cause adhesions which may at some time in the future cause a blockage of the bowel when the adhesion lies across the bowel wall and kinks off the lumen. Other causes of obstruction include abdominal wall hernias due to the bowel becoming entrapped in the hernia and tumors which may grow within the lumen of the bowel or compress the bowel from the outside of the bowel wall.

The patient experiences abdominal cramping pain, bloating and nausea and vomiting. The abdomen becomes distended and the patient stops passing both gas and stool from below.  This obstruction is usually diagnosed with a CT scan. This condition is treated by admission to the hospital to give the patient IV hydration and insertion of a nasogastric tube. This tube is passed through the nostrils down into the stomach to suck out the excessive gastric and small intestine contents upstream of the blockage.  In most cases of obstruction due to adhesions, once the bowel is decompressed with the nasogastric tube, the pain improves, the nausea resolves and the bowel may untwist on its own, thereby relieving the obstruction.  In this way, most patients with a bowel obstruction avoid an operation.  In cases in which the blockage does not resolve an operation is needed to reopen the bowel. 

Colonic Volvulus

Volvulus or twisting of the colon to a degree that obstructs the lumen is an uncommon condition.  It most commonly occurs in the elderly but can at times be seen in young healthy individuals. The distal or sigmoid colon is the most common portion of the colon that can undergo this type of twisting.  Patients experience the symptoms of a bowel obstruction with pain, abdominal distention and inability to pass either gas or stools.  A CT scan will often reveal the presence of the volvulus. Volvulus is a true emergency because if the bowel twists enough it can cut off the blood supply to the colon and causes it to perforate. In most cases the colon can be untwisted by expertly inserting a colonoscope and maneuvering the scope to carefully untwist the bowel.  Once this is done the patient feels instant relief and the emergency is over.  However, the patient will usually be advised to have that portion of the bowel removed electively in the near future as recurrence of the volvulus is very likely.

Ischemic Colitis

Ischemic colitis is a condition in which the inner layer of the colon wall experiences injury due to not receiving enough blood flow through the tiny vessels of the bowel to keep it healthy.  The lining develops ulcerations and sloughs off resulting in pain and bleeding.  This condition most commonly occurs in patients who have pre-existing vascular disease.  These patients may have narrowing of the arteries that bring blood to the bowel.  If they experience a period of low blood pressure or become dehydrated the vessels to the bowel may experience a further decrease in blood flow resulting in bowel wall injury.  This condition is manifested by rectal bleeding, often passing blood clots with stools, and some abdominal pain.  The diagnosis is aided by finding on a CT scan and often a sigmoidoscopy or colonoscopy will be performed to asses the degree of damage to the bowel.  Treatment centers on rehydrating the patient and treating the underlying cause of their ischemia.  In most cases the bowel wall will heal if adequate blood flow is restored.  In cases in which the bowel wall has developed injury to the full thickness of the wall the patient may require an urgent operation to remove the injured segment of the colon.

Lower Intestinal Bleeding

There are a wide variety of causes of massive lower intestinal bleeding.  These include but are not limited to diverticulosis, arteriovenous malformations of the colon or small intestine, inflammatory bowel disease, ischemic colitis, colon cancer, small bowel tumors, Meckel’s diverticulum of the small intestine.  All of these entities can give rise to a situation in which the patient passes large volumes of blood per rectum to the point that this can become a life threatening condition.  The surgeons of Fairfax Colon and Rectal Surgery work in consort with the gastroenterologists and other physicians in the care of these patients.  There are a number of radiologic and tests and scans that may be required to determine the location of the bleeding site in the bowel and the underlying cause.

Fortunately most episodes of small intestine and colonic bleeding stop on their own or can be controlled with either radiologic or colonoscopic interventions which avoid an operation. In cases in which the bleeding continues despite all non-operative maneuvers, there is little choice but to operate to remove the portion of the bowel that contains the source of the bleeding.  The extent of that surgery is dependent upon the patient’s particular situation and the underlying cause of the bleeding.