Sigmoidoscopy - endoscopic examination, in which the mucous examined direct and distal sigmoid colon (lat. Rectum - the rectum, sigma romanum - sigmoid colon). Research carried out by a special unit - a sigmoidoscopy, which is a tube (25-35 cm in length and 2 cm in diameter) lenses, and a lighting device for the discharge of air.
Sigmoidoscopy in Russia began to perform in the 19th century (SP Fedorov and his disciples). Currently, this manipulation is widely used in medicine for detection of intestinal diseases.
Sigmoidoscopy allows you to inspect the intestinal mucosa during the 15-30 cm from the anus and identify various pathologies, as in this procedure, the opportunity to take a biopsy (tissue site for histological examination under a microscope). This study is also a preparatory stage before the other studies intestine (barium enema, colonoscopy).
- Suspicion of cancer pathology straight or sigmoid colon;
- Intestinal bleeding, mucus or pus from the rectum;
- Violations of the chair (long constipation, diarrhea, or change in the nature of a chair);
- Chronic inflammatory diseases of the rectum (for example, chronic paraproctitis);
- Chronic hemorrhoids (to assess the status of internal hemorrhoids);
- In men with suspected prostate tumor in women - with suspected pelvic tumor;
- As a preparatory step to the further examination of the intestine (barium enema, colonoscopy);
Sigmoidoscopy intestine may be medical procedure, such as colon polyps of small size is possible to remove by endoscopic education.
Contraindications to this manipulation is a serious condition of the patient (eg, severe cardiovascular disease, severe degree of respiratory failure, cerebrovascular accident), where the risk of sigmoidoscopy exceeds its feasibility.
Relative contraindications to the survey are acute inflammatory diseases of the anus (paraproctitis sharp, acute thrombosis of hemorrhoids nodes, anal fissure).
In an emergency (eg, excessive intestinal bleeding with loss of consciousness), sigmoidoscopy bowel can be performed virtually any patient emergencies.
Technique of sigmoidoscopy
This manipulation is performed in a specially equipped room. Typically, a sigmoidoscopy is performed without anesthesia (the procedure is almost painless). In some cases local anesthesia (eg, if the patient has an anal fissure or traumatic injury to the anus). Intravenous Anesthesia is used in rare cases, at the insistence of the patient.
Before sigmoidoscopy sure to first performs a digital rectal examination. During the manipulation position of the patient can be Bozeman (the patient stands on "all fours", based on the knees and elbows) or lying on the left side.
Proctoscope tube inserted 4-5 cm after a heavy lubricating the anus with vaseline oil. Then, the manipulation is performed under the control of the eye, in the tube apparatus is pumped air for straightening the folds of mucous. The patient must explain that as we move proctoscope he may appear the urge to defecate, this is normal. At a height of 12-14 cm is usually bend intestine (rectum transition in the sigmoid), so at this point requires maximum relaxation of the patient for further passage proctoscope. Since during rectoscopy bowel blown air, the patient may receive the discomfort and pain in the lower abdomen. If the study is extremely painful for the patient, then it stopped.
Blood, mucus and liquid stool, which prevent the carrying out a detailed examination of the mucous is removed electric pumps. When conducting sigmoidoscopy may take the material for histological or cytological examination (using biopsy forceps, a special brush, cotton swab). It histological examination in case of formation answers about its purity. In the case of the procedure with curative intent is possible to remove the polyp by a coagulation loop.
In very rare cases, possibly sigmoidoscopy bowel bleeding (eg, after a biopsy or removal of polyps) and perforation of the intestine (the formation of a defect in the wall of the intestine). In case of perforation requires urgent surgery.
Preparing for sigmoidoscopy
To thoroughly examine the mucosa inside requires special preparation (cleaning the bowel) prior to the study.
Methods of preparing includes dietary restrictions - for 24-48 hours before the procedure to eliminate from the diet of fruits, vegetables and roughage. In some hospitals sigmoidoscopy performed only on an empty stomach. Purification bowel conducted in different ways and depends on the preferences of the physician.
The following methods of preparation for sigmoidoscopy:
- Enema (first performed on the eve of their study in the evening, and the day of the study in the morning - at least 3 hours before the procedure);
- With the help of laxatives taken by mouth (eg, Duphalac, Fortrans, forlaks, fleet);
- With special mikroklizm with a laxative effect (Mikrolaks). Maybe use this medication immediately before the study, which reduces the time of preparation (2-3 microclysters 30-40 minutes prior to the survey).
Preparing for sigmoidoscopy should be careful, because the study is not informative if not sufficiently clean the intestines. Perhaps a combination of cleansing enemas and laxatives, especially true in patients with constipation.
Sigmoidoscopy in young children is carried out only under general anesthesia (intravenous). To perform the study, a special children's rectoscopy smaller size.
Preparing for sigmoidoscopy in children is different from adult training (can be used laxatives and cleansing enemas).
The indications for sigmoidoscopy children are intestinal bleeding, loss of tumor formations, hemorrhoids, or bowel wall (mucosa prolapse). With the help of this study can detect anomalies of the distal colon, recognize ulcerative colitis, proctosigmoiditis, and other pathologies.
Contraindications to sigmoidoscopy children are peritonitis, inflammatory changes in the anus, the narrowing of the anus.