Chapter 32. Large Intestine
Proctectomy requires pelvic dissection and has the potential to cause injury to the nerves that supply the rectum, pelvic floor muscles, and bladder, as well as the prostate and seminal vesicles in men. Which of the following associations is incorrect regarding the nerves at risk at different points in the operation?
A. Superior hypogastric plexus near root of inferior mesenteric artery
B. Hypogastric nerves in the retrorectal space
C. Nervi erigentes near lateral stalks
D. Inferior hypogastric plexus near Denonvilliers fascia
The correct answer is D. Inferior hypogastric plexus near Denonvillier fascia
A 60-year-old man presents with abdominal pain, fevers, and nausea. He is febrile, focally tender in the left lower quadrant, and has a white blood cell count of 18,000/µL. Computed tomography (CT) shows sigmoid diverticulitis with a 4-cm pericolonic abscess. What is the optimal management strategy for this patient?
A. Bowel rest and intravenous fluids
B. Bowel rest, intravenous fluids, and broad-spectrum antibiotics
C. Bowel rest, intravenous fluids, broad-spectrum antibiotics, and percutaneous drainage
D. Urgent exploratory laparotomy
The correct answer is C. Bowel rest, intravenous fluids, broad spectrum antibiotics, and percutaneous drainage
An otherwise healthy 60-year-old man presents with abdominal pain. His CT shows an obstructing mass in the sigmoid colon with dilation of the cecum to 13 cm. After fluid resuscitation, what is the next step in management?
A. Nasogastric decompression and observation
B. NPO (nothing by mouth), antibiotics, and observation
C. Flexible sigmoidoscopy with biopsies to further evaluate the mass
D. Exploratory laparotomy
The correct answer is D. Exploratory laparotomy
A 65-year-old, asymptomatic woman is found to have a 3-cm sessile polyp in the ascending colon on screening colonoscopy. It was biopsied but could not be resected. Pathology shows tubulovillous adenoma. What is the next step in management?
B. Colonoscopy in 3 years
The correct answer is D. Right hemicolectomy