How a Colorectal Surgery expert witness can help with a medico-legal case

February 11, 2022
by McCollum Consultants

Our expert witnesses in colorectal surgery specialise in the care of individuals suffering afflictions to the lower part of their gastrointestinal system. This includes the large intestine (colon), rectum, anus, and the appendix.

Our expert witnesses in colorectal surgery have a wealth of experience in conditions such as Crohn’s disease, ulcerative colitis, and diverticular disease, bowel cancer, and anorectal disorders. Their extensive experience in the operating theatre means they can review operation notes and assess the practical nature of the colorectal procedures performed.

With a strong understanding of appropriate standards of care and NICE Guidelines, in addition to a thorough knowledge of treatment pathways, our expert witnesses in colorectal surgery can advise on causation, breach of duty, current condition, and prognosis in individuals with colorectal conditions and injury.

See below for a brief overview on colorectal surgery. Alternatively, contact an expert witness in colorectal surgery to see how they can help.

What is Colorectal Surgery?

The lower gastrointestinal tract is comprised of the ascending colon, transverse colon, descending colon, caecum, rectum, and anus. It functions to extract water from our faeces, before facilitating the excretion from the body. When things go wrong, individuals experience abdominal pain, bloating, changes in bowel habit (diarrhoea and constipation), and sometimes exhibit bleeding.

The Colon

The colon is a long muscular tube which uses peristalsis (wave-like muscle contractions) to move faeces towards the rectum and anus. As the faeces passes through the colon, water is absorbed through the bowel wall. Problems arise when the colon becomes inflamed, obstructed, perforated, or twisted, or when the superior mesenteric artery (SMA) that supplies blood to the bowel becomes blocked, leading to an ischaemic bowel.

Some individuals have autoimmune diseases, such as Crohn’s disease and ulcerative colitis, that lead to inflammation and bowel dysfunction. Other individuals develop diverticular disease (diverticulosis) where there is outpouching of their bowel wall. These pouches can become inflamed or infected (diverticulitis) and develop into abscesses, and in some cases, toxic megacolon.

Bowel obstruction can occur due to something within the bowel, such as colon cancer or hardened faecal matter, or as a result of something external putting pressure on the bowel. Small growths (polyps) may develop inside the bowel; whilst these are often completely benign, the can become cancerous.

Rectum & Anus

The final portion of the gastrointestinal tract includes the rectum and anus. This area is susceptible to developing engorged veins (haemorrhoids) which can be uncomfortable, may bleed, and in rare circumstances become ischaemic. Although these can be managed conservatively, colorectal surgical intervention may be required by way of haemorrhoidectomy. The rectum and anus are also susceptible to trauma e.g., through childbirth, and the muscular structure can become damaged, leading to a rectal prolapse. Further, communications from the rectum can develop, called fistulas. These fistulas can extend to various places, including the vagina, bladder, and surrounding soft tissues. The fistulas allow passage of bacteria from faecal matter to enter these places, causing widespread infection and occasionally abscesses e.g., perianal abscesses.

The Appendix

An accessory of the colon is the appendix. This can become inflamed (appendicitis) which may lead to the appendix rupturing. To avoid the appendix rupturing and leaking contents into the abdomen, an appendicectomy is performed to surgically remove the appendix.

Endoscopic Investigation of the Lower GI Tract

The inside of the lower gastrointestinal tract can be viewed using a variety of imaging methods. Most commonly, endoscopic procedures, such as colonoscopy and sigmoidoscopy, are performed to take pictures of the inside of the bowel and take biopsies of growths found within.

Colorectal Surgical Procedures

Common surgical colorectal procedures include colectomy, sigmoidectomy, haemorrhoidectomy, fistulotomy, hemicolectomy, and abdominoperineal resection (APR). These will often result in the formation of a stoma, either a colostomy or ileostomy.