Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_929_Библиотеки_им_академика_М_И_Перельмана.pdf
Colorectal Surgery
Mark Killingback, AM, MS(Hon), FACS(Hon),
FRACS, FRCS, FRCSEd
Colorectal Surgery
Living Pathology in the
Operating Room
Mark Killingback, AM, MS(Hon), FACS(Hon), FRACS, FRCS, FRCSEd
18/1 Lauderdale Avenue
Fairlight 2094
Australia
Library of Congress Control Number: 2006921548
ISBN-10: 0-387-29081-8
ISBN-13: 978-0387-29081-2
Printed on acid-free paper.
© 2006 Springer Science+Business Media, Inc.
All rights reserved. This work may not be translated or copied in whole or in part without the written
permission of the publisher (Springer Science+Business Media, Inc., 233 Spring Street, New York, NY
10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in
connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden.
The use in this publication of trade names, trademarks, service marks, and similar terms, even if they
are not identified as such, is not to be taken as an expression of opinion as to whether or not they are
subject to proprietary rights.
While the advice and information in this book are believed to be true and accurate at the date of going
to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any
errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect
to the material contained herein.
Printed in China. (BS/EVB)
987654321
springer.com
To Bobbie, my wife of more than 50 years, who has made many
sacrifices as the wife of a surgeon and without whom this work
would not have been completed.
To Sir Ian Todd, who supported my appointment as a Resident
Surgical Officer to St Mark’s Hospital in 1960, which determined
my career path in surgery.
To my mentors, the late Edward Wilson and the late Sir Edward
(Bill) Hughes, who were pioneers in colorectal surgery, master surgeons, prolific authors, innovators, and valued friends.
Foreword
Books addressing the issues of colorectal surgery tend to take a familiar
format. Frequently multiauthored, especially for comprehensive presentations on current status of the specialty, there are few single authored
texts available. As for this book by Mark Killingback, one is not aware
of any comparable treatises devoted to colorectal surgery. So what makes
this so unique? And what makes the acquisition and reading of this
book so desirable? First, a certain amount of historical perspective. Until
this time—and one hopes for sometime yet to come—descriptions of
findings at operation, and what was done to correct them, have been
considerably augmented—and clarified—by schematic diagrams. (The
reference to “sometime to come” is based on the emergence of the echart and e-operative note which promises to make such documents
entirely paperless).
Dr. Killingback throughout his distinguished and prolific career has
practiced the habit of schematically representing his operations—after
the intervention—usually with captions. It is a practice he taught many
of us. This exemplifies the phrase “a picture is worth a thousand words.”
However in the course of time, he acquired the skills of an artist and so
converted basic line drawings into an art form.
Well, that is nice, you might say. But what does this offer over and
above a good photograph of the specimen or of the operative field? This
is the distinguishing point. Note how difficult it is to convey the spectrum of the disease or the extent of the difficulty of an operation or show
manifestations of a particular syndrome in a photograph—or even a conventional line drawing! How does one adequately convey to the reader,
the tapestry, the protean manifestations of Crohn’s disease, for example,
in a single drawing? In Dr. Killingback’s imagery, all the features of thickened, strictured, obstructive, perforative, fistulizing, and ulcerated
intestines are shown in one masterful piece of art. Photographic attempts
for similar documentation are fortunate to provide two or three such
features.
The experienced surgeon will appreciate this book by recognizing the
details and exquisitely rendered images that call to mind similar cases
encountered. For the surgeon or trainee relatively new to the specialty of
colorectal surgery, the graphic presentation of the surgical pathology,
with the accompanying succinct and informative text will make the
acquisition of this book a valuable one.
Victor W. Fazio, MD
Cleveland, OH
Stanley M. Goldberg, MD
Minneapolis, MN
vii
Preface
This book makes no claims to be a textbook of colorectal surgery, as
many aspects of this specialty are not included. It is rather a collection
of cases illustrating surgical pathology as encountered by a surgeon performing operations for colorectal disease. The surgeon is the first, in what
may be a succession of medical practitioners, to confront the pathology
of the disease “face to face.” It is a unique opportunity to see the pathology in vivo in its undisturbed state and the interpretation of this morphology is usually vital to the operative technique to follow. In 1907
Moynihan of Leeds General Infirmary (UK) wrote on one of his favorite
themes “The Pathology of the Living.”1He stressed the value of observations of pathology during abdominal surgery and how this influenced
diagnosis and treatment. The title of this book is related to this philosophy of surgery proposed by Moynihan. The aim of this work is principally to present illustrations of surgical pathology with artistic merit for
surgeons to include in their reference library as a “coffee table book” but
the author hopes the art and case history texts will have a significant
educational role. Perhaps its main value will be for the younger surgeon
who is commencing the journey into unchartered waters of surgical
pathology. The author certainly would have valued a forewarning of
many of the cases presented in this publication.
Drawing was selected for the illustrations as an art form rather than
photography. Illustrative art has the facility to probe into inaccessible
areas of the abdomen, to manipulate perspective to include important
details, and to emphasise or delete various parts of the subject. Illustration can also combine the internal and external views of a viscus, etc.,
in the one diagram.
The author has enjoyed a long standing interest in drawing and
usually included this aspect in operation report records. The contribution of the medical artist to surgical education was emphasized to the
author in 1958–1959 while working as a surgical registrar at the Central
Middlesex Hospital London. Ms. Mary Barber was a full-time medical
artist employed by the hospital working in a very small cottage in the
hospital grounds. With watercolor painting, the artist produced beautiful
illustrations of surgical specimens. Most of her work was generated by
the senior surgeon, T.G.I. James, who himself had a great interest in
recording surgical pathology. The quality of Ms. Barber’s work can be
seen in her illustration of bowel affected by necrotising colitis
1). Although this type of artwork has been somewhat overshadowed by
color photography, perhaps this book will demonstrate that there is still
value in illustrative artwork. The evolution of the illustrations has been
presented in three stages. On completion of an operation the author’s
practice was to open the specimen and pin the bowel to a corkboard for
the pathologist. A rough sketch was made to record details. This sketch
formed the basis for an improved diagram for the patient’s record (Figure
2). Such diagrams have then facilitated third illustrations prepared for
this book. The author practiced colorectal surgery as a specialty for 26 of
the 39 years of operating experience. Patients described in this book were
2
(Figure
ix
x Preface
Figure 1: Necrotizing colitis. (Painting by M. Barber, 1959)
managed by the author, who performed the surgery on the pathology
depicted in all cases, with the exception of: Case 21, lipomatosis-referred
after retirement; Case 49, composite diagram; Case 78, desmoid tumourno operation and Case 79, pneumatosis-no operation. The observations
are therefore personal and prospective. The author has maintained his
own detailed records of all patients treated, and this has restricted a
minimum need for retrospective searching of patient details in hospital
records. Follow-up cases were routine in patients with neoplastic disease,
but in many cases not requiring follow-up for management. The patients
have been located by the author and follow-up details were established
by phone. A number of patients underwent related operations by other
surgeons either prior to the author’s involvement or subsequently. The
stated age of the patient is that at the time of the initial referral.
Many surgeons have an interest in recording operation details by diagrams which can become invaluable in the management of the patient.
Victor Fazio attributes his interest in this method of recording operation
details, to his mentor the late Rupert B. Turnbull Jr. who was an enthusiastic sketcher of what he observed in the operating room. There are a
few publications, however, that feature medical artwork by surgeons. Sir
Charles Bell (1774–1842), of London, was a surgeon-anatomist and a talented artist who illustrated many texts with neuroanatomical drawings.
His famous paintings of war wounds from the Napoleonic wars are now
with the Royal College of Surgeons of Edinburgh.3Bateman in his book
Berkeley Moynihan Surgeon relates that in the early part of the 1900s