Hemicolectomy

Hemocolectomy is a surgical procedure where blood is removed from the legs through a catheter. This procedure was first performed on patients with hemophilia A (an inherited clotting disorder) back in the 1950s. Today, it’s used to treat other conditions such as Crohn’s disease or Ulcerative colitis. Hemocompatibility refers to how well the body tolerates blood products given during this operation. Hemo is a combination of two words: hemoglobin (Hb) and coagulation. Blood carries oxygen around your body; when there isn’t enough oxygen in the blood, tissues start dying off and eventually die out completely. When too much oxygen enters the bloodstream, tissue death occurs faster than normal.

Blood clots are formed in various parts of the body. They form because of several factors including:

• Age – Blood clots may occur if you’re older than 50 years old.

• Smoking – People who smoke have higher risks of developing blood clots.

• High cholesterol levels – If you have high cholesterol levels, your risk of having blood clots increases.

• Family history – If any immediate member of your family has had blood clots, then you are at an increased risk of developing the condition.

Treatment options may vary, depending on your symptoms and how bad the condition is. You can manage the risk factors by getting treatment and living a healthy lifestyle. Symptoms can worsen over time or they may remain the same. Severe symptoms should be brought to the attention of a doctor immediately.

There are many different types of blood clots. You may be diagnosed with one or more of the following:

Thrombosis is a common condition where a localized clot blocks or partially blocks blood flow through a blood vessel. If clots occur in your heart, it’s known as a coronary thrombosis. Clots that affect blood vessels in your brain are known as cerebral thrombosis. Clots that affect the blood vessels in your legs are known as deep vein thrombosis or DVT for short.

If a clot occurs in your arm, then it’s known as an upper-extremity DVT (UE-DVT).

Pulmonary embolism (PE) is a sudden blockage of an artery in your lung by a clot (thrombus) originating from elsewhere in the body. If the clot completely blocks the artery, it’s known as aorto-ostial PE. If only a part of the artery is blocked, it’s known as partial thrombotic obstruction of the pulmonary artery (POPA).

A VTE that affects the femoropopliteal arteries (the main arteries of the legs) is known as a DVT of the legs. If the DVT affects the anterior tibial and peroneal arteries, it’s known as an Air Traveler’s Thrombosis (ATP). If the DVT affects the popliteal artery in the back of the leg, it’s known as a Traveler’s Thrombosis (TT).

A VTE that affects the carotid arteries in the neck is known as a Carotid Embolism (CE). A VTE that affects the retinal arteries is known as a Retinal Embolism (RE).

In addition to different types of blood clots, there are different types of VTEs. There are three main types:

VTEs occur when the blood clots at a faster rate than it normally should. When this happens, clots can form in the blood vessels of various parts of your body. If clots form in your lungs or legs, this is known as a Venous Thrombosis (VTE).

A VTE is a serious condition that occurs when blood clots form in one or more of your blood vessels. There are many different types of blood clots, all of which can be life-threatening if they become severe. Venous thrombosis occurs when blood clots form in a vein (vena).

The mediastinum is the space between the lungs and the heart.

You develop pain and swelling in your legs, along with redness on your skin. You immediately make an appointment with your primary care physician, who orders a CT scan of your chest.

The best way to determine if you have a blood clot is to perform a CT scan of your lungs and a CT angiogram of your abdomen.

A Doppler ultrasound of your legs may prove useful.

In addition, your doctor orders a D-dimer test (a lab test that measures the amount of a certain enzyme in your blood) to confirm or refute the existence of clots in your lungs.

To rule out the presence of clots in your lungs, your doctor orders a chest x-ray. She also orders an electrocardiograph (EKG) to see if you’re at risk of having a myocardial infarction (heart attack).

After an uncomfortable night of sleep, you wake up in the morning feeling tired and worn out. You limp over to the bathroom and take a shower.

Your medical team decides to keep you in the hospital under observation. They want to make sure that you don’t have any more clots in your lungs or legs.

Your first night in the hospital is uncomfortable. Since your legs are sore, you have a hard time falling asleep. When you do manage to drift off, you toss and turn because of the dull ache in your legs.

Your primary care physician orders a low molecular weight heparin (LMWH) to put directly into your vein. The LMWH helps prevent further clotting. Since he doesn’t want you to walk around, he’ll have a nurse come in and apply compression stockings to your legs. These stockings have elastic bands at the top that put constant pressure on your legs, which pushes the blood down in your legs (and keeps it from pooling).

Your doctor prescribes aspirin (81 mg). Aspirin helps reduce the pain and swelling caused by your clots.

You are given warfarin (Coumadin) to further prevent blood clots from forming in your lungs or legs. Warfarin is a powerful blood thinner. By taking this medication, your risk of having another blood clot is significantly lowered.

Your doctor also orders an Omniscan scan of your legs. The Omniscan is an x-ray scan that checks for clots in your legs. If the test comes back positive (i.e you have more clots in your legs), then you’ll be put on blood thinners (Coumadin or Warfarin) to help break up the clots in your legs.

Your doctor orders an echocardiogram to look at your heart. He is specifically looking for any sign of damage to the heart muscle. The echocardiogram comes back normal.

You have a history of alcoholism and cocaine abuse, so your doctor orders a CT scan of your head, neck, and chest to look for signs of an enlarged heart or heart attack. Your physician is also looking for any sign of bleeding in your brain and neck.

An angiogram will reveal any potential blockages in your leg and arm arteries. If your doctor finds that you are in imminent danger of a heart attack or stroke, he could go in and remove the blockage(s) to restore blood flow to your limbs.

You settle into your hospital bed. You’re given food that is easy to digest and not spicy (no onions, no garlic, no red meat). You have difficulty sleeping due to leg pain. You drift in and out of sleep throughout the night.

In the morning, a team of doctors come to your room. They will be guiding a catheter through a large incision in your groin up to your heart and branching arteries. The catheter is equipped with a tiny video camera, and wires that can measure the size of your artery, as well as a means of flushing the area with blood thinner medication.

The cardiologist begins to explain the procedure, but you don’t understand any of it.

Sources & references used in this article:

Single port access laparoscopic right hemicolectomy by P Bucher, F Pugin, P Morel – International journal of colorectal disease, 2008 – Springer

Laparoscopic-assisted right hemicolectomy by RT Schlinkert – Diseases of the colon & rectum, 1991 – Springer

Laparoscopic vs open hemicolectomy for colon cancer by E Lezoche, F Feliciotti, AM Paganini, M Guerrieri… – Surgical …, 2002 – Springer

Single-incision laparoscopic right hemicolectomy for a colon mass by AM Merchant, E Lin – Diseases of the colon & rectum, 2009 – journals.lww.com

Robotic assistance in right hemicolectomy: is there a role? by AL deSouza, LM Prasad, JJ Park… – Diseases of the colon …, 2010 – journals.lww.com

Curative resection for left colonic carcinoma: Hemicolectomy vs. segmental colectomy by F Rouffet, JM Hay, B Vacher, A Fingerhut… – Diseases of the Colon & …, 1994 – Springer