What is a bowel perforation or hole in your colon and what are the symptoms? Who is at risk? And how is a perforation treated? Overview Your colon is composed of layers of smooth muscle and mucous membranes. The innermost layer, called the mucosa, is soft and pliant—similar to the tissues in your mouth. Bowel perforations occur when a hole is made in this lining, often as a result of colon surgery or serious bowel disease. A hole in the colon then allows the contents of the colon to leak into the usually sterile contents of your abdominal cavity. Symptoms The symptoms of a bowel perforation can vary and may come on slowly or rapidly depending on the underlying cause. Symptoms may include: Abdominal pain (often severe and diffuse) Severe abdominal cramping Bloating Nausea and vomiting A change in your bowel movements or habits. Rectal bleeding Fever (usually not immediately) Chills Fatigue Risk Factors Scientists have found that a number of factors may increase your risk of developing a bowel perforation. These include both factors involved in surgery or a procedure (iatrogenic causes) and bowel diseases characterized by inflammation. Risk factors may include: Recent or prior abdominal. Recent or prior pelvic surgery. Age greater than 75. History of multiple medical problems. Trauma to the abdomen or pelvis (such as in an automobile accident.) A history of diverticular disease. A history of inflammatory bowel disease. Colon cancer Use of the monoclonal antibody immunotherapy drug ipilimumab. Pelvic adhesions (scar tissue, usually related to previous surgeries.) Female gender (women typically have a more flexible colon, which can lead to accidental perforation during medical procedures, including a colonoscopy.) Diagnostic and surgical procedures involving the digestive tract, abdomen, or pelvis. Risk factors for a perforation during a colonoscopy include being female, older age, a history of diverticular disease, and bowel obstructions. Causes Bowel perforations may occur spontaneously (unexpectedly) as a result of a medical condition or instead be a complication of various diagnostic and surgical procedures which accidentally create a hole in the colon. Trauma, especially blunt trauma to the abdomen, is also an important cause of bowel perforations. Procedure associated causes include: Enema – An improperly or forcefully inserted rectal tube for an enema can rip or push through the colon lining. Bowel preparation for colonoscopy - Rarely, the bowel preparation for a colonoscopy can result in a perforation. This is more common in people with a history of constipation. Sigmoidoscopy – Although the endoscope for a flexible sigmoidoscopy is flexible, perforation remains a risk, but a rare one. Colonoscopy – The tip of the endoscope has the potential to push through the inner lining of the colon, although this is a rare complication of the procedure and is not seen in the virtual colonoscopy. Perforation of the bowel associated with a colonoscopy is more common in those who have the severe acute disease of the bowel as well as those who are on steroid medications. The colonoscopy perforation rate appears to be around 1 in 1400 people who have screening colonoscopies and 1 of 1000 people who have a therapeutic colonoscopy (for example, to remove a polyp.) Abdominal or pelvic surgery, particularly colon surgery as for colon cancer. Causes of spontaneous bowel perforation (those unrelated to surgery or procedures) include: Inflammatory bowel disease/colitis such as Crohn's disease and ulcerative colitis. The lifetime risk of a bowel perforation with Crohn's disease is between one and three percent, making this a very common cause. Severe bowel obstruction, especially when the colon is "weakened" by diverticular disease, another process, or cancer. Trauma. Ischemic bowel disease (when the blood supply to the colon is compromised.) Colon cancer. Foreign body ingestion - Most commonly due to the ingestion of fish bones, and bone fragments, as well as non-food items. Severe bowel impaction. Diagnosis If your doctor suspects a bowel perforation, she can order tests to confirm her suspicion. A simple abdominal x-ray may show gas outside the colon but is not often diagnostic. A CT scan of your abdomen with or without contrast or a barium enema or swallow may be needed. A complete blood count may show an elevation of your white blood cell count if the perforation has been present for a while, or evidence of anemia due to bleeding. Small perforations may sometimes take several imaging studies and time to accurately diagnose. Treatment Perforation of the bowel is considered a medical emergency and requires immediate treatment. Left untreated, the contents of the bowel can leak out and cause inflammation, infection and even abscesses in your abdomen. The technical name for this is peritonitis, which is a painful precursor to sepsis—or a body-wide infection. The majority of perforations are surgically repaired. Depending on the location and size of the tear, the doctor might be able to fix it through an endoscope, similar to the one used during a colonoscopy—but this is not an option for everyone. Open bowel surgery may or may not result in a stoma and colostomy: an artificial opening outside of your stomach where stool drains into a small bag until the bowel is healed. Complications Complications of untreated perforation may include: Bleeding Infection (peritonitis and sepsis) Death Complications depend on a person's general health, as well as the amount of time it has taken to diagnose and treat the perforation. Recovery During your initial recovery period, you will not be able to drink or eat anything by mouth. This is called resting the bowels and allows the inner lining time to heal properly. You will also have a nasogastric tube in place to drain the contents of your stomach for a period of time. You may receive intravenous antibiotics and nutrition for a few days if you're in the hospital. Although you may be anxious to return to your normal routine, it's important that you give your colon time to heal properly, and follow your doctor's orders. The Bottom Line Bowel perforation may occur spontaneously, such as with inflammatory bowel disease, or during surgery or diagnostic tests. Symptoms may come on rapidly, or instead slowly, and should be considered in anyone who has risk factors for a perforation combined with risk factors for the condition. When caught early, there are different treatment options available, but even with surgery (which is most often required) the bowel can often be preserved and repaired without a colostomy. Recovery can take time, both for healing, and to correct and risk factors which led to the perforation.

Hemorrhoids are varicose (enlarged and swollen) veins around the outside of the anus or in the lower rectum. The rectum is the last part of the bowel that leads to the anus, the opening at the end of the bowel where fecal matter leaves the body. Everyone has hemorrhoidal tissue in this area that’s made up of blood vessels, connective tissue, and some muscle. These “cushions” don’t always become enlarged or distended, but as we age, this phenomenon becomes more common — causing what we call hemorrhoids, also known as piles. Hemorrhoids can be caused in a number of ways, often by straining to make a bowel movement. Lifting heavy objects, along with other activities that may cause straining, can also lead to hemorrhoids. Experiencing increased pressure during pregnancy and being overweight are other contributing factors. Hemorrhoids may be painful and particularly bothersome if they are recurrent, but they are not dangerous or life-threatening, and symptoms usually go away within a few days. There are plenty of effective ways to treat them, as well as options for the less common types of hemorrhoids that may be more problematic.

Anal Fistula When an irregular false tract occurs between the inside of the rectum and the outside skin surface, an Anal Fistula forms. The anal fistula is classified according to the condition of the tract and the relation of the internal opening to the anal sphincter muscle. Most commonly, this condition develops because of an anal abscess that went untreated. The anal abscess itself is usually the result of a small gland that becomes infected. The most common symptoms are pain, recurrent swelling, pus discharge and discomfort during the discharge of stool. The most common treatment in India is a surgical treatment; the most common method is the minimally invasive Video Assisted Anal Fistula Treatment. Symptoms What are the typical symptoms of anal-fistula? Swelling around the anal area Redness around the rectal area Pus drainage Rectal pain. Causes What causes anal fistulas? It usually occurs as a result of some damage to the tissue around the anus. It begins as a sort of inflammation in the rectal area. Later, it becomes an abscess which gets regularly infected and reinfected by faeces. This causes the fistula to form near the anus. If the fistula seals over, pus can start accumulating. Because of this pus-drain, anal fistulas can be very painful. Anal fistulas usually occur because of: An injury caused by constipation Anal glands becoming infected Crohn’s disease Abscess of the large intestine

An Inguinal Hernia is a gap in the strong tissue in the abdomen which holds the stomach muscles. It occurs in the abdominal muscles and weakens them which cause a bulge in the stomach. Hernia causes discomfort and pain in the stomach. Both men and women can get inguinal hernia. Symptoms of Inguinal Hernia: It can cause a severe pain in abdomen especially in pelvis region. The later symptoms also result in swelling and severe pain in the testicles or groin area. Apart from that the patients who are suffering from inguinal hernia have a problem in walking straight and straining the abdominal muscles by lifting up some things. Diagnosis: The diagnosis of this type of hernia is physical examination as the doctor can see and feel the bulge. For further diagnosis other tests like ultrasound and CT scan is also done. Treatment and Recovery: The surgery of inguinal hernia is done with laparoscopic approach with the help of instrument called laparoscope. Small incisions are made in the abdomen to insert the laparoscope and treat the hernia. This technique is also known as keyhole surgery. Patient takes about 1 to 2 weeks to get properly recover after the surgery. They have to wait atleast for 4 weeks to start exercising after the operation.

What does it mean varicose veins endovenous ablation? vein-ablation-procedureVaricose pathology and its best methods of treatment have been developed for the last decades. Duplex ultrasound testing and its widespread promotion influence on varicose pathology treatment. Duplex ultrasound testing gives a doctor an opportunity to examine the reason of varicose veins appearance. Blood flows through arteria from the heart into legs and back to the heart through veins. Duplex ultrasound image depicts veins and gives an opportunity to check the blood flow. Ultrasound testing should be done while treating any varicose pathology in order to find out the blood flow direction that leads to varicose veins appearance. Leg veins have non-return valves that that block the blood from running down. If the valves do not work properly (so called ineffective valves), the blood inspissates and leads to varicose veins. Individual plan of treatment will be worked out for every patient, after an ultrasound testing and after veins examination by a doctor. Individual plan of treatment consists of: Endovenous laser ablation means a closure of an injured vessel by using laser energy. Endovenous radiowave ablation a closure of an injured vessel by using radiowave energy. Ultrasound sclerotherapy means that a special medicine (called sclerosant) is used to block veins. Miniflebectomy is a surgical removal of damaged veins with minimal cuts (5mm). Preparation of varicose veins to ablation csm_mapping_prae_op_1_01_9be4aee32cA surgeon will discuss with a patient, beafore planning the procedure, all the nuances of the procedure, probable complications, all the advantages and disadvantages of treatment and probable alternatives. A patient should inform a surgeon about all the medicine he or she takes in, about disease he or she has and about allergies ( local anesthetic allergy or allergy n medicine that is used during scleropherapy). A surgeon, before a procedure, may advise you to stop using blood thinners drugs, nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen etc) or can offer alternative drugs. Come to a procedure in comfortable clothes, all the jewellery should be erased as well. Special supportive tights should be worn after the procedure. They may be bought in pharmasy or a patient may buy them in our clinic. Supportive tights should be worn for 24 hours after a procedure (or longer according to doctor’s order ), and then tights should be worn for 5-10 days. Moderate pain and irritation may appear during the several days after the treatment, a surgeon will reccomend you suitable analgetic. Veins treatment is done by local anesthesia and general anesthesia is not needed. Laser and radiowave ablation Ultrasound veins testing has been done before the treatment. It has been done in order to identify the size of treated area. A leg is washed and shaved if it is needed, it is also aseptisized. If laser energy is used during the procedure, the special glasses will be given to a patient. Laser or radiowave probe is injected under local anesthesia. Laser or radiowave catheter, under ultrasound control, is injected into injured veins through small holes. Injured area treatment has been done under local anesthesia. Laser ray or radiowave catheter sends energy pulse that closes veins. A detector moves through a vein and closes it step by step. Veins, that are situated nearby, are remained intacted. Later laser ray or radiowave catheter is erased, bleeding is stopped by pressure. The cut is tapd by plaster. Supportive tights are put on the legs. After the treatment images-8Discomfort, measurable pain, swelling and bruises may appear after the treatment.Taking into consideration swelling and bruises can appear and the fact that you should wear supportive tights we reccomend you to plan your treatment during cold season. Partial loss of sensetivity may appear in treated area for some days. In some cases the recovery may last up to 6 months. Inflammation may, rarely, appear after 7 -21 days and it may last up to 10 days. If a patient feels intention in a shin-bone, swelling or redness of a treated area please contact the clinic. Mostly all of treated veins disappear after the procedure; some of them may be noticed during 6 months. Skin colour may be yellow in treated area, the colour will disappear in some weeks. How long veins ablation treatment takes? The treatment takes 45-60 minutes. If a surgeon reccomends you to compound the treatment with other varicose veins prosedures (for example,withminiflebectomy, sclerotherapy) it takes 1,5-2 hours. If two legs need to be treated, we reccomend to take two procedures within one month (one leg may be treated for oneprocedure ). Supportive tights or stockings should be worn for 30-45 minutes every day. Are there any complications of endovenous ablation? Endovenous ablation is quite safe and does not have any complications. There are not any scars left after the treatment. One patient out of 1000 may have wound infection. Antibiotics treatment is needed in case of inflammation. Some patients seldom have swelling and bruises, supportive tights will help in this case. Complications based on nerve injury are quite uncommon. One patient out of twenty may have an inflammatory reaction of treated veins that may be treated easily by using nonsteroidal anti-inflammatory drugs (ibuprofen, for example, and etc.). Cooling compress is quite effective as well. Deep vein thrombosis is a dangerous complication. In order to prevent it, we maintain a control after the treatment. Varicose veins are a chronic issue, even after the treatment it can appear in other areas. According to some investigations the ablation method proves its effectiveness. It is effective in 85-97% even in 10 years after the treatment. Endovenous ablation advantages There is no need to do any surgical cuts in case of intravenous ablation. 2 mm cuts have been done during the treatment and there is no need of saturation. In comparison with surgical intervention there are less complications and pain during endovenous ablation. Endovenous ablation treatment is a minimally invasive alternative of surgical intervention. The majority of patients stop complaining about itch, swelling and heavy legs after the procedure. Patients may quickly turn to daily routine. When should patients feel the result of the treatment? The result of endovenous ablation appears immediately in 95-100% cases and it remains the same in 85-97% cases in ten years. Due to the results of investigations, radio-wave ablation treatment proves its effectiveness in 99.6% cases for a term of two years Not so many investigations are held that could show us how patients spend their daily life after the treatment, but life becomes better. Endovenous ablation is regarded as a “gold standard” in many developed countries. Treatment in Estmedica Clinic The majority of modern, widespread technologies and different methods of varicose treatment are acceptable in our clinic. World leaders in medicine sphere teach our doctors. They use different treatment methods that provide minimally invasive treatment of varicose veins.

Hernias will not go away by themselves. Surgery is the only way to repair a hernia. A hernia repair returns the organ or structure to its proper place and fixes the weakened area of muscle or tissue. Having surgery is a big decision. It can be tempting to put it off, and that may be okay in some cases. Before you decide, make sure you understand the risks and benefits of your decision. Here are some things to consider and discuss with the doctor who is helping you make the decision. How Is the Hernia Affecting You? The first thing to consider is whether or not you are experiencing symptoms. Not everyone has symptoms with a hernia, especially small ones. When symptoms occur, the most common one is pain. Others can include a feeling of heaviness or fullness in the belly or groin. Whether you have symptoms or not, a hernia can also interfere with your leisure activities and your work. So you also need to recognize if you are taking time off from work or interests due to your hernia. Delaying surgery may mean you spend more time away from work and fun instead of returning to activities after recovery. If you have symptoms, especially pain, your doctor is likely to recommend surgery. But what if you don’t have symptoms or they are minimal? In this case, your doctor may recommend watchful waiting. Before you agree to watchful waiting, be sure your doctor knows the whole story. Be honest about any limitations your hernia puts on your time and activities. What Are the Risks of Waiting? 1. Hernias can become incarcerated. One potentially serious risk of not fixing a hernia is that it can become trapped outside the abdominal wall—or incarcerated. This can cut off the blood supply to the hernia and obstruct the bowel, resulting in a strangulated hernia. This requires urgent surgical repair. Not all hernias progress to this point, but it is a risk nonetheless. Avoiding an emergency situation that you can’t control is one reason to consider not delaying surgery. 2. Hernias grow. A more likely scenario is that your hernia will continue to grow and weaken with time. This is likely to increase your symptoms, including pain, and cause more changes to your lifestyle. Surgeons know that smaller hernias are easier to repair than larger hernias. Going ahead with surgery instead of delaying it can prevent your symptoms from getting worse. It can also help you avoid losing work or missing activities. 3. Hernias require surgery eventually. Even if you aren’t having symptoms, you may still want to consider having surgery sooner rather than later. Surgery for a hernia is somewhat inevitable in most cases. Research shows that most people with hernias have surgery within 10 years. Keep in mind that delaying surgery until your hernia is larger and the muscles are weaker may make surgery and recovery more difficult. 4. Your overall health may change. Your age may determine whether waiting is a risk for you. Putting off surgery for years down the road may mean you are not in as good overall health or physical shape. This will also affect your surgery and recovery. So having surgery at a younger age can be beneficial. However, if you are elderly (older than about 75 years of age), not very active, and your hernia isn’t causing problems, it may be better to not fix it. The risks of surgery may outweigh the benefit of repair. Making the Decision Surgery is never convenient and life is always busy. Being in control of when you have surgery is a huge benefit of not delaying your hernia repair. You can schedule your surgery at your convenience. And if you are a candidate for laparoscopic hernia surgery, you’ll be back to life and work sooner than in years past. Surgery should be easier on you and recovery will likely be smoother at a younger age and with a smaller hernia. Ultimately, your doctor is best able to help you decide whether watchful waiting or surgery is the best option for you.

Laser Surgery for Varicose Veins