Introduction
When removing the colon, the most important goal is that the patient can continue to be stool-continent. There are two ways to ensure the intestinal passage for this purpose. The first method is to connect the small intestine with the rectum.
By forming a pocket in the small intestine, one tries to create a similar reservoir as in the large intestine and to maintain the usual faecal continence. The other possibility is the formation of an artificial bowel outlet. In this case, the small intestine is connected to the abdominal wall on the outside. In this case, however, the stool is emptied involuntarily via the abdominal wall into a bag.
Reasons for a colonectomy
The complete removal of the large intestine is usually avoided, as otherwise the patient’s quality of life may be impaired. However, a large intestine removal is recommended, for example, if the risk of colon cancer is very high. There are various diseases that play a role in this:
- Familial Adenomatous Polyposis (FAP) is a disease in which 100% of cases are associated with colorectal cancer.
It is an autosomal dominant inheritance of the disease to descendants. The disease is based on a germline mutation in the APC gene. FAP is characterized by an extremely high incidence of colon polyps.
- Ulcerative colitis is a chronic inflammation of the intestinal mucosa in the colon.
Ulcerative colitis has a significantly increased risk of colorectal cancer after a prolonged period of disease progression. If the entire colon is affected, the risk is significantly higher after 8-10 years, and after 12-15 years if the colon is left-sided.
- Crohn’s disease is also an inflammatory bowel disease, although it is not primarily limited to the colon, as is the case with ulcerative colitis, but can affect the entire intestinal passage system.
- A rectal herniation describes a prolapse of the rectal mucosa from the anus. It is caused by weak pelvic floor muscles.
This clinical picture is more common in women, especially after several births.
- Colon carcinoma is a malignant new formation of the colon. Of these neoplasms, over 90% are adenocarcinomas, i.e. neoplasms that originate from glandular tissue. With a probability of about 70%, colon carcinomas occur in the area of the rectum and the sigmoid colon. With decreasing frequency, they form in the ascending colon and in the remaining sections of the intestine.