Cancer lower rectum

Q) False statement about management of cancer rectum

a) Relative to ERUS, pelvic MRI is more accurate in its ability to detect lymph node involvement 

b) Rectal cancers located in the upper third of the rectum are exempt from neoadjuvant treatment.

c)  TME is typically performed 2-3 weeks after completion of CRT before fibrosis develop

d) ERAS  include early mobilization, transition to oral pain control, and resumption of oral food intake

Pouchitis after IPAA in ulcerative colitis

Q) Which of the following is Not a risk factor for pouchitis post IPAA in ULcerative colitis

A) Smoking
B ) NSAIDs use post op
C) Elderly patients
D) UC with extra intestinal manifestation


Ans a

Pouchitis is the complication of Ileal Pouch Anal Anastomosis (IPAA) for Ulcerative colitis. The incidence of pochitis for the same proedure for familial Adenomatous polyposis is less than 10% but for ulcerative colitis can go as high as 50%.

Risk factors for development of pouchitis are

  1. Previous extra intestinal manifestations of IBD especially arthritis
  2. ANCA positive cases of UC
  3. NOD2insC  positive patients
  4. Smoking prevents the development of puchitis after IPAA in ulcerative colitis.

5. Other reported factors that may associate with pouchitis include extent of UC, thrombocytosis,and PPI use with  NSAId

Ref - https://onlinelibrary.wiley.com/doi/full/10.1111/den.12744

lymphatics of colon

Q ) Which of the following group of lymph nodes do lymphatics of the colon first drain to?

a) Paracolic

b) Epicolic

c) Nodes along SMA/IMA

d) Para aortic
Answer to 37


37) b

Lymphatics first drain to epicolic group along the bowel wall

Then paracolic group along the marginal artery

Intermediate group along the named vessels SMA/IMA

Finally to par aortic 

Colon and upper 2/5 of rectum --- Para aortic

Lower 1/5 of rectum and anal canal - Superficial inguinal lymph nodes

Ref Sabiston-1317