Auto Text: “Insert Colon Resection UC”

Triage

1. These colectomy specimens consist of a small portion of terminal ileum (proximal resection margin), appendix (if present), and the entire abdominal colon.
2. The rectum may be sent as a separate specimen in another container (one stage procedure), or in a subsequent operation weeks to months later (two stage procedure).
3. Open the specimen longitudinally along the anti-mesenteric border, remembering to include the few centimeters of terminal ileum, which will be stapled closed.
4. Check the requisition and prior biopsy history.  If there is high grade dysplasia or adenocarcinoma, then treat the specimen as a colon for neoplastic disease.  Try to find the area of dysplasia / carcinoma based on location of prior biopsy.
5. Make the following measurements:
   • Length of terminal ileum segment and inner circumference
   • Length of the colonic segment and inner circumference
   • Circumference of the colon at the widest point of the cecum and at the distal resection margin
   • Circumference of any dilated or strictured portion of the specimen and length of the dilated or strictured portion
   • Distance from any lesion to the closest resection margin
   • Length and diameter of the appendix
6. Photograph the specimen if it is particularly interesting.
7.  Wrap in gauze and fix for at least 30 minutes prior to grossing to facilitate acquisition of adequate mucosa on submitted sections.

Gross

1. Review the previous biopsy results to determine whether dysplasia had been diagnosed. If so, numerous sections should be obtained from the approximate area where the dysplasia was located, remembering that 10-15 cm of rectum should be mentally “tacked on” to the distal end of the colectomy specimen so that the location sampled roughly corresponds to the colonoscopic measurements. Dysplastic mucosa sometimes has a slightly raised, velvety or granular appearance, but may also be grossly inapparent.
2. Longitudinal sections of the terminal ileal proximal resection margin and distal colonic margin.
3. Appendiceal tip and cross sections from center and base.
4. Sequential sections every 10 cm from distal to proximal. These sections should be chosen to include transitions between normal, quiescent, and actively involved segments.
5. Representative sections of inflammatory polyps.
6. Any other lesion, especially areas of velvety, firm, granular, or slightly raised mucosa which may represent dysplastic change.
7. Representative sections of easily located pericolonic lymph nodes. One cassette of several lymph nodes is sufficient. If cancer or dysplasia is noted or identified then an extensive lymph node search should be conducted.