Colorectal Surgery (Demo)

A 28-year-old male presents to the clinic with a 2-week history of a discharging sinus in his natal cleft. The patient reports intermittent pain and swelling around the area, which has worsened over the last few days. He describes a small amount of pus-like discharge that occasionally contains hair fragments. The patient also reports discomfort when sitting for extended periods but denies fever, chills, or significant bleeding. Upon physical examination, there is a palpable, tender swelling in the natal cleft with a sinus tract present. No signs of systemic infection are observed. The patient has no significant medical history and denies any prior surgeries in the region. He is otherwise healthy and works as a software engineer. He leads a sedentary lifestyle and has no history of trauma or recent weight changes. On further questioning, he mentions that he has had similar, albeit less severe, episodes of drainage in the past but never sought medical attention. He is currently seeking treatment as this episode has been particularly troublesome, affecting his ability to perform daily activities. The doctor suspects a pilonidal sinus based on clinical presentation and orders a local examination. The examination confirms the diagnosis. Which statement is false?

A 62-year-old man is diagnosed with rectal cancer after undergoing diagnostic workup, including colonoscopy and imaging. No evidence of metastatic disease is found. The tumor is located 2 cm from the anal verge. On MRI, the tumor is classified as T2, N0, indicating no involvement of the regional lymph nodes. The patient is otherwise in good health, with no comorbidities that would complicate surgery. Given the location of the tumor, which of the following represents the most appropriate course of action?

A 78-year-old woman from a nursing home is admitted with a 24-hour history of absolute constipation and abdominal pain. On examination, she has a distended abdomen with a soft mass in her left iliac fossa. An X-ray is performed, which shows a large dilated loop of bowel in the left iliac fossa containing a fluid level. Based on the clinical presentation and radiographic findings, what is the most likely diagnosis?

A 78-year-old woman is admitted with a 3-hour history of passage of dark red blood per rectum. Prior to this event, she was otherwise well with no major medical co-morbidities. On examination, she has mild tachycardia but other vital signs are normal. Her abdomen is soft and non-tender. A digital rectal examination reveals dark blood but no other findings. What is the most likely underlying cause of the rectal bleeding?

A 30-year-old woman presents with painful bright red bleeding that occurs post defecation. Digital rectal examination is too uncomfortable for the patient, but perineal inspection shows a prominent posterior skin tag. What is the best course of action?