Colorectal surgery referrals

COVID-19 and Colorectal Surgery referrals

In common with most other specialties, we are changing the way we work over the next few months and in particular who we see in outpatient clinics.
The elderly, the immunocompromised, those with IHD, men and smokers appear to be at greater risk of infection with Covid-19 and these demographics are highly pertinent to our patients. Elective surgery is being greatly curtailed.
We therefore plan to restrict outpatients to urgent referrals.
All referrals will be vetted using the following criteria:

Simple fissure in ano – no referrals will be accepted. If you suspect please prescribe GTN 0.4% BD or diltiazem 2%bd along with dietary measures. If you suspect cancer follow 2WW advice.
Incontinence of faeces – no referrals will be accepted. Please consider Imodium.
Constipation: no referrals will be accepted. Please treat with laxative, glycerine suppositories or enema as required.
Abdominal mass: Follow 2WW advice. FIT test and CT scan abdomen and pelvis. If unsure refer to us.
Abdominal pain – Please refer for CT scan or Ultrasound examination depending on age. Referral can be sent for advice. But if the pain is persisting prior imaging will help us to triage hospital visit.
Difficulty in rectal evacuation – FIT test and Follow 2WW current advice. This could be benign rectocele or pelvic floor problems. So if FIT test is negative these patient can potentially this can wait.
Suspected colorectal cancer (weight loss or unexplained symptoms) and doesn’t fit into 2WW- FIT test. Consider booking CT scan Chest+Abdomen+pelvis.
Fistula in Ano /pilonidal sinus– If patients can wait, consider referring after few weeks/months.
Skin tags/haemorrhoids– Consider referring after few weeks/months (Banding of haemorrhoids is not being currently performed)
Any patient meeting 2WW criteria please consider referral based on current guidance during the COVID-19 pandemic.