Who knew the rectum was so much fun?

Today I was in clinic all day. And since it is my last week of Surgery II, I decided to try rectal clinic instead of Post Op. I had heard (from other students) that the Rectal surgeon on Coney Island is very good....and very quizzical when it comes to students. He not only pimps....he super pimps. He treats you as a resident in rectal surgery and fires question after question after question at you until your brain starts screaming STOP!!!! But, that is what made this clinic so much fun for me. Because he made me think....hard. And after only 2 hours, I felt like I learned and accomplished so much. So, let me briefly review the wonderful world of the rectum.

The first patient was an older male who was diagnosed with Carcinoid tumor of the colon that was resected. The doctor brought up his most recent labs which showed an elevated 5-HIAA. This is a marker for Serotonin, which is released from this kind of tumor. First question to me, what does this mean for this patient? My response: metastasis to a distant site. Good (first one down), now what sites are commonly involved? My response: liver and lungs. Very good (now I was feeling a bit cocky), now what 2 radiology studies, 5 blood tests, 3 clinical signs and one very important test will you order? OUCH!!! I got about half right, which isn't bad for my first try. By the way, the answers according to this doctor are: Radiology: CT scan, Octreotide Scan; Blood tests: 5-HIAA, Liver function tests, Serotonin, Chromogranin A, CEA; Clinical signs: Flushing, sweating, diarrhea; Important test: Colonoscopy.

The next few patients all had hemorroids, either internal or external. The external ones were easy to find...just spread the buttocks apart and you can easily see them. The internal ones were more tricky. A speculum type of device was placed in the rectum and slowly removed to show the presence of any internal hemorroids. I also got the wonderul opportunity to perform digital rectal exams on all of these patients.

On two of the patients I had the opportunity to perform a sigmoidoscopy. This is a device that allows you to see the mucosa of the rectum. And by blowing up a little balloon on one end, you can advance the device further into the rectum to the sigmoid colon, which is the most distal portion of the colon. Of course, I ran into a bit of a problem on the last patient. I tried to advance the scope and I ran into a big wall of pooh which allowed me absolutely no visibility. I had to retract the scope and the doctor informed the patient that he would need to come back again to have the procedure, but this time taking an enema prior to the appointment.

Overall this was one of the most challenging clinics I had ever attended and for a few moments I thought to myself "Hey, I could totally be a colo-rectal surgeon!!" :)