Colon for diverticulitis: Difference between revisions

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{{Comprehensiveness|otherlegend=yes}}
{{Comprehensiveness|otherlegend=yes}}
==Gross processing==
==Gross processing==
As per [[Colon#Gross processing]].
[[File:Gross pathology of diverticulitis with diverticular abscesses.jpg|thumb|Longitudinally opened colon (inside/mucosa at top and outside/serosa at bottom), showing diverticulitis with two diverticular abscesses (white arrows). The dark coloration at right is previous colon tattooing for localization.]]
As per [[Colon#Gross processing]]. Make multiple longitudinal cuts to look for inflamed diverticuli. {{Moderate-begin}}Measure the deepest diverticulum found.{{Moderate-end}}


Strive to sample 4-8 lymph nodes.
Look for any '''perforation'''. {{Moderate-begin}}Look in the operative report for any suspicion of perforation, mandating extra careful look if not directly found grossly.{{moderate-end}}


===Tissue selection===
===Tissue selection===
Line 15: Line 16:
*Mesenteric margin{{Moderate-end}}
*Mesenteric margin{{Moderate-end}}
*Diverticuli
*Diverticuli
*Strive to sample 4-8 lymph nodes.
*{{Finding-begin}}Representative sections of any "'''[[Stoma|donuts]]'''"{{Finding-end}}
*{{Finding-begin}}Representative sections of any "'''[[Stoma|donuts]]'''"{{Finding-end}}


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Template:
Template:
{|class=wikitable
{|class=wikitable
| {{Moderate-begin}}A. Labeled - __.<br>The specimen is received in formalin and consists of{{Moderate-end}} a segment of large intestine which measures __ cm in length and __ cm in average diameter. The serosal surface is tan and smooth. {{Comprehensive-begin}}The proximal surgical margin is inked blue and the distal surgical margin is inked green. The mesenteric margin is inked red.{{Comprehensive-end}} The specimen is opened longitudinally to reveal a smooth mucosa. There are multiple diverticula measuring up to __ cm in depth. The rest of the mucosa is tan-pink with normal mucosal folds. The lumen is not dilated. The wall measures __ cm in thickness. Within the mesorectum there are __ possible lymph nodes measuring up to __cm in greatest dimension. {{Finding-begin}}Also included in the container are __ unremarkable colonic [[stoma|donuts]] measuring __ and __ cm in diameter.{{Finding-end}} Representative sections are submitted for microscopic examination in __ cassettes.
| {{Moderate-begin}}A. Labeled - __.<br>The specimen is received in formalin and consists of{{Moderate-end}} a segment of large intestine which measures __ cm in length and __ cm in average diameter. The serosal surface is tan and smooth. {{Comprehensive-begin}}The proximal surgical margin is inked blue and the distal surgical margin is inked green. The mesenteric margin is inked red.{{Comprehensive-end}} The specimen is opened longitudinally to reveal a smooth mucosa. There are multiple diverticula {{Moderate-begin}}measuring up to __ cm in depth{{Moderate-end}}. The rest of the mucosa is tan-pink with normal mucosal folds. The lumen is not dilated. The wall measures __ cm in thickness. Within the mesorectum there are __ possible lymph nodes measuring up to __cm in greatest dimension. {{Finding-begin}}Also included in the container are __ unremarkable colonic [[stoma|donuts]] measuring __ and __ cm in diameter.{{Finding-end}} Representative sections are submitted for microscopic examination in __ cassettes.
|}
|}
==Microscopic evaluation==
[[File:Histopathology of a diverticular abscess.jpg|thumb|Diverticular abscess, showing partially obliterated mucosa and acute and chronic inflammation. The lumen has some neovascularization.]]
Look for:
*Diverticular inflammation. If found:
:*Microscopic perforation (transmural inflammation with obliteration of histologic layers)
Example report:
{|class=wikitable
| Rectosigmoid colon, segmental resection:<br>Chronic diverticulitis with abscess and focal microscopic perforation.<br>Negative for malignancy.<br>{{Comprehensive-begin}}Surgical margins negative for neoplasia.{{Comprehensive-end}}<br>Six (6) representative benign pericolic lymph nodes.
|}
{{Bottom}}
{{Bottom}}

Latest revision as of 12:06, 9 December 2022

Author: Mikael Häggström [note 1]
This article is about a resection of part of the colon (usually part of or including the sigmoid colon):

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))
Other legend

<< Decision needed between alternatives separated by / signs >>
{{Common findings / In case of findings}}
[[Comments]]
Link to another page

Gross processing

Longitudinally opened colon (inside/mucosa at top and outside/serosa at bottom), showing diverticulitis with two diverticular abscesses (white arrows). The dark coloration at right is previous colon tattooing for localization.

As per Colon#Gross processing. Make multiple longitudinal cuts to look for inflamed diverticuli. (Measure the deepest diverticulum found.)

Look for any perforation. (Look in the operative report for any suspicion of perforation, mandating extra careful look if not directly found grossly.)

Tissue selection

  • (Proximal surgical margin, en face[note 2]
  • Distal surgical margin, en face
  • Mesenteric margin)
  • Diverticuli
  • Strive to sample 4-8 lymph nodes.
  • {{Representative sections of any "donuts"}}

Gross report

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))
Other legend

<< Decision needed between alternatives separated by / signs >>
{{Common findings / In case of findings}}
[[Comments]]
Link to another page

Template:

(A. Labeled - __.
The specimen is received in formalin and consists of) a segment of large intestine which measures __ cm in length and __ cm in average diameter. The serosal surface is tan and smooth. ((The proximal surgical margin is inked blue and the distal surgical margin is inked green. The mesenteric margin is inked red.)) The specimen is opened longitudinally to reveal a smooth mucosa. There are multiple diverticula (measuring up to __ cm in depth). The rest of the mucosa is tan-pink with normal mucosal folds. The lumen is not dilated. The wall measures __ cm in thickness. Within the mesorectum there are __ possible lymph nodes measuring up to __cm in greatest dimension. {{Also included in the container are __ unremarkable colonic donuts measuring __ and __ cm in diameter.}} Representative sections are submitted for microscopic examination in __ cassettes.

Microscopic evaluation

Diverticular abscess, showing partially obliterated mucosa and acute and chronic inflammation. The lumen has some neovascularization.

Look for:

  • Diverticular inflammation. If found:
  • Microscopic perforation (transmural inflammation with obliteration of histologic layers)

Example report:

Rectosigmoid colon, segmental resection:
Chronic diverticulitis with abscess and focal microscopic perforation.
Negative for malignancy.
((Surgical margins negative for neoplasia.))
Six (6) representative benign pericolic lymph nodes.

Notes

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
  2. ↑ En face means that the section is tangential to the region of interest (such as a lesion) of a specimen. Further information: Gross_processing#Cutting

Main page

References


Image sources


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