CEBU VELEZ GENERAL HOSPITAL

CEBU INSTITUTE OF MEDICINE

Department of Surgery

Activity: 1. Colorectal and Hernia Census (December 2017)

2. Preoperative Case Presentation: Anal mass (Hemorrhoids)

Date: January 26, 2018 12:30pm Venue: CIM Room 201

1. The General Surgery conference was moderated by Dr. Loreto Ong. It started with the discussion of
learning issues. Aschoff-Rokitansky sinuses and indications of ERCP were subsequently discussed by Dr.
Nikki Velez as the first speaker. Dr. Ligo verified with Dr. Nikki Velez that another name for diverticulosis is
Achoff sinuses. Dr. N. Velez started enumerating the indications for ERCP. Dr. Stephen Siguan expressed
that one must not simply enumerate the indications but to take note of the question and answer it as
this will serve as evidence of having learned something -- something that we are able to apply. In this
connection, we are to answer clinically oriented questions as much as possible and not just things that
are knowledge base as added by Dr. Siguan. Dr. Loreto Ong said that he thinks the question last time
specifically asked about “which is better between preoperative and post operative ERCP.” Dr. Nikki Velez
replied that laparoscopic CBDE is better than post operative ERCP, as to preoperative ERCP versus post-
operative ERCP; they have not found any literature regarding it. Dr. Ong suggested answering this next
time by presenting a journal regarding the said topic.

2. Dr. Oporto asked about the indications and contraindications of ERCP.

3. December 2017 Census for the colorectal subservice was presented by Dr. N. Velez. One of the
patients presented was diagnosed with Rectosigmoid adenocarcinoma, Stage 3, ruled out metastasis. Dr.
Siguan asked how she ruled out metastasis, if there was an ultrasound or CT scan done. A clinical and
pathologic staging can be done and management will depend on the said matter. “May I know about the
polypectomy,” Dr. Siguan added.

4. Role of protective ileostomy was asked by Dr. Dy and Dr. Siguan.

5. Identification of the risk factors of anastomotic leak present in the index patient to justify performing
protective ileostomy on the said patient was asked by Dr. Ong.

6. Dr. Dy asked about what conditions that brought the decision to do protective ileostomy despite
preoperative measures done to reduce risk of anastomotic leak.

7. Dr. Dy and Dr. Siguan asked on the indications of neoadjuvant chemotherapy on rectal carcinoma.

8. Dr. Ong said operative findings showed a movable mass and that the pathologic report showed
unremarkable intestinal tissue. Dr. Dy remarked, “what if it is malignant? Operate again”

9. Dr. Abalos asked about the final diagnosis. Dr. N. Velez replied that what they used was the final
histopathologic diagnosis.

10. Dr. Siguan remarked to never put a different procedure or diagnosis just because of Philhealth
purposes.
11. Dr. Abalos asked if the patient in question had presented generalized peritonitis. Dr. Ong added a
query if the patient present any clinical signs indicating such.

16. Pre-operative case about a patient with anal mass was presented by Dr. Jeanette Canoy. History and
physical exam of patient was presented. Diagnosis of mixed hemorrhoids and plan for
hemorrhoidectomy was presented.

17. Dr. Coronel asked where the pain is most prominent at present.

18. Dr. Dy asked on why one must do a proctosigmoidoscopy on the said index patient. He also asked
about the conditions that will call for a surgical treatment. Dr. Canoy responded, “Grade IV hemorrhoids
and thrombosed hemorrhoids” Dr. Ong added to read on when surgery is indicated for.

19. The conference ended and the meeting of surgical consultants started.

Prepared by:

Carmelli Fernan
Post-Graduate Intern

Noted by:

Dr. Rocelda Mirasol

Department Secretary