Recto-manoscopy: preparation and procedure

sigmoidoscopy is widely used in the diagnosis of diseases of the intestine, doctors proctology, gastroenterology, oncology, Infectious disease. This simple but informative procedure can also be prescribed for minimally invasive surgical manipulations.

Early diagnosis of a large intestine tumor gives the patient the chance of a complete cure. With the preventive purpose, it is recommended that patients undergo rectoscopy every year after 50 years.

What is a sigmoidoscopy

Rectoromanoscopy of the intestine is an examination of the rectum and the end section of the sigmoid colon using a sigmoidoscope instrument. A rectoscope is a metal or plastic tube( the diameter of which is 2 cm and the length is up to 35 cm) equipped with lenses to increase the mucosal area under examination, the lighting system and the air injection device. Special children's rectoscopes are used for the study of children.

Features of the procedure

The procedure of sigmoidoscopy allows the doctor to examine the mucosa of the distal parts of the colon at a distance of 15-30 cm from the anal sphincter.

Modern rectoscopes with fiber optics and lighting system allow detecting pathology at an early stage. The video camera of the device makes it possible to display images of the mucosa and conduct simple proctologic operations on the screen, to document the results obtained.

In the diagnostic sigmoidoscope there are differences from the operating device, which has an additional channel for the introduction of special instruments( loops for removal of polyps and forceps for taking a biopsy).The modern medical equipment market also offers disposable sigmoidoscopes, more hygienic.

Recto-manoscopy is a painless or safe procedure. With surgical manipulation, it is accompanied by anesthesia. Complications in the form of vascular damage and bleeding or perforation of the intestinal wall are extremely rare.

Indications and contraindications

Intestinal rheumatomoscopy can be performed with a therapeutic and diagnostic purpose.

Indications for diagnostic sigmoidoscopy:

• pains in the lower abdomen;
• prolapse of rectum;
• stool disorder - constipation, diarrhea or alternation;
• pathological admixtures in feces - mucus, blood, pus;
• Intestinal bleeding;
• chronic inflammation in the rectus and sigmoid colon - nonspecific ulcerative colitis, chronic dysentery, chronic paraproctitis, etc.;
• chronic hemorrhoids;
• intestinal infections;
• fistulas of the rectum;
• a suspicion on the oncology of the large intestine;
• prostate cancer in men or suspected of it;
• a tumor of organs in the small pelvis in women.

Recto-manoscopy is also conducted as preparation for another diagnostic study - colonoscopy, irrigoscopy. More details about what is better - sigmoidoscopy or colonoscopy →

During the procedure it is possible to take a material for histological examination( bilpsia) with the help of special forceps, flush with mucous membrane or take a sterile swab of fingerprints for clinical and bacteriological examination.

Therapeutic manipulations with sigmoidoscopy:

• endoscopic removal of small polyps;
• stop bleeding by electrocoagulation of the bleeding vessel;
• widening of the lumen of the gut with its narrowing;
• removal of foreign body.

There are no absolute contraindications to the procedure.

Relative contraindications to sigmoidoscopy:

• severe general condition of the patient( pulmonary heart disease severe, etc.), in which the risk of conduction is higher than the diagnostic value of the procedure;
• narrowing of the intestinal lumen acquired, for example, due to a tumor or congenital;
• Acute inflammation in the rectum or abdominal cavity;
• acute anal fissure;
• acute hemorrhoids, complicated by thrombosis of hemorrhoids.

In all these cases, the sigmoidoscopy is postponed for a while( for the necessary conservative treatment) or carried out with great care, in a gentle position, under anesthesia.

The procedure should also be postponed if a radiological examination of the gastrointestinal tract with barium was made during the last week, since its residues may make examination difficult.

With massive intestinal hemorrhage, sigmoidoscopy is performed to the patient according to vital indications to clarify the cause and source of bleeding.

Preparation

For qualitative and detailed examination of the mucosa it is necessary to prepare for a sigmoidoscopy. Preparation of the patient includes cleansing of the intestine and a slag-free diet. The preparation of children does not differ from that of adults. The diet is recommended 3-4 days before the test.

It is necessary to exclude the use:

• fruit and vegetables;
• beans;
• flour and bakery products;
• alcoholic and carbonated beverages;
• fried and fatty foods;
• seasonings;
• chocolate.

Food should be easily digestible. During the day before the procedure, it is permitted to eat broth, semolina porridge, scrambled eggs, jelly, kissel, yoghurt. In the evening you can drink meat broth, weak tea, water without gas, clear juices. Most doctors carry out an examination on an empty stomach.

Preparation of the intestine can be done in different ways - cleansing enemas or using special medications( Fortrans, Fleet, Dufalac, Forlax).

The cleansing enema with the help of Esmarch's mug is placed with tap water with warm water( with a temperature of 37-38 degrees) the previous evening and in the morning, but no later than 3 hours before the test, so as not to affect the results of the examination. The intestines are washed 2-3 times in the evening and in the morning with an interval of 30 minutes. On the degree of purification of the intestine depends on the informative value of the results of sigmoidoscopy.

Medication-based bowel cleansing

Preparation for the procedure is carried out with the help of medical preparations for bowel cleansing - it is a safe, gentle way that does not affect the microflora and biological processes. One of these drugs is Fortrans, which is completely eliminated with calves.

The action of the drug slows the absorption of fluid, it accumulates in the lumen of the intestine, causes liquefaction and the elimination of feces. When preparing for a sigmoidoscopy by Fortrans, the patient does not have abdominal pain or emptying. In some patients, the drug may cause an allergic reaction.

The dose of the drug is calculated by the patient according to body weight: 20 kg - 1 sachet. If the weight requires 2.5 sachets, then round to three. Powder from 1 packet should be diluted in 1 liter of water( reduce the volume of water can not be) and drink for 1 hour. If there is nausea, then after each drink, you can suck a piece of lemon.

Time of reception of Fortrans depends on the time of the sigmoidoscopy. If it is scheduled for the morning, then the day before after 12 hours you can not eat. At 14-15 hours take 2 sachets of the drug. Then after a break of 1 hour you need to take the rest of the dose. Emptying of the intestine usually occurs 1-2 hours after the first dose of the drug and ends 4-5 hours after the last glass of the drug.

When the procedure is scheduled for the 2nd half of the day, 2 bags of powder should be taken the day before after 18 hours, and the remaining dose should be drunk at 7 am. Purification of the intestine will begin in 30 minutes.

You can clear the intestines to prepare for the remoromanoscopy with Mikrolaks, which is administered in the form of 2-3 microclysters in about 40-60 minutes. Before the procedure, that is, preparation takes considerably less time. The dose for an adult is 5 ml of the drug.

Before use, it is necessary to break the seal in the tube of Mikrolax, lubricate the tip with petroleum jelly, insert it completely into the rectum and squeeze the contents of the tube to the end. Cleansing of the intestine will begin in 15 minutes.

With persistent constipation, you can combine cleansing enemas and laxatives.

How to make a sigmoidoscopy

You can make a sigmoidoscopy in the office of endoscopic research in a polyclinic or in a hospital. The procedure is often performed without anesthesia. The study is conducted with the written consent of the patient.

Local anesthesia is used in some cases: traumatic damage, cracks, surgical manipulation. At the insistence of the patient, intravenous anesthesia can be used. To children of younger age the procedure is carried out only under general anesthesia.

Before sigmoidoscopy, the rectum is examined by the doctor's finger and anoscopy - examination of the mucosa using a rectal mirror. The doctor, putting on rubber gloves, probes inside the rectum and examines on the glove the possible presence of blood, mucus, feces. An anoscope allows you to examine the anal canal at a distance of up to 14 cm for the presence of a tumor, hemorrhoids and assessing their condition. Only after this, the patient is given a sigmoidoscopy.

Step-by-step administration of sigmoidoscopy:

1. The patient takes a knee joint position on a special table. If you can not stand on all fours, the patient is placed on the left side with legs tucked up to the stomach. The anal area is covered with a clean or disposable napkin.
2. The rectoscope tube, lubricated with petrolatum oil, is injected gently into the rectum by 5 cm. Further progress of the tube is performed under the visual supervision of the physician. The patient should breathe calmly and deeply.
3. To facilitate the progress of the tube and spreading of the mucous folds, air is pumped into the intestine. This can cause a feeling of urgency for defecation and discomfort in the lower abdomen. If in the lumen of the intestine mucus, blood, liquid stools interfere with the research, then they are painlessly removed by an electro pump.
4. The rectoscope is entered to the full depth. Inspection of the intestinal mucosa is performed by the doctor during the slow extraction of the sigmoidoscope. If necessary, a biopsy material is taken or other surgical procedures( after local anesthesia).
5. After extraction of the rectoscope, the patient is recommended to lie down for a few minutes on the back to avoid a drop in blood pressure when the body is suddenly turned into a vertical position.
6. After removal of the polyp or biopsy, blood can be discharged from the anus.
7. If intravenous anesthesia was used, then the patient should not drive the vehicle within 24 hours and consume alcohol. It's best to go home with his relatives.

Recto-manoscopy refers to instrumental reliable methods of diagnosing diseases of the terminal area of ​​the large intestine. Endoscopic procedure allows not only to detect oncopathology, clarify the source of intestinal bleeding, but also to take a biopsy material, remove the polyp, ligate the bleeding vessel.

Author: Valentina Tikhonova, physician,
specially for Moizhivot.ru

Useful video about sigmoidoscopy