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Rigid Sigmoidoscopy and Proctoscopy

Contents

1. Definition
2. Indications
3. Complications
4. The Sigmoidoscope and Proctoscope
5. Procedure

1. Definition

2. Indications

• Any symptom which suggests colonic neoplasia
• To investigate inflammatory bowel disease
• For taking biopsies of any pathology within direct visualisation
• Before any ano-rectal operation/procedure
• Proctoscopy - to treat/band haemorrhoids

3. Complications

• Perforation of the colon - the main risk. Can be due to
  • Mechanical reasons such as pushing the tip of the colonoscope against weak sites of the colon wall such as diverticula, areas of inflammation or just before strictures.
  • Pneumatic reasons - over inflation with air
  • Risk is increased with poor bowel preparation
• Bleeding - Delayed bleeding may occur following banding of haemorrhoids, and this can occur up to one week after the procedure. Delayed bleeding usually stops on its own but in some severe cases laparotomy/colonoscopy may be required.
• Infection - can lead to a gram negative bacteraemia

4. The Sigmoidoscope and Proctoscope

• The rigid sigmoidoscope with obturator (top)

• The light source, bellows and eyepiece

• The Sigmoidoscope set up
  • Light source on
  • obturator placed through eye piece
  • Bellows to hand

• The Proctoscope
  • Introducer in place
  • Light source is attached to blue component

5. Procedure

• As the technique is usually performed in the outpatients department, no sedation or bowel preparation is usually given.
• However for good views a suppository should be given prior to the examination
• Positioned in the left lateral decubitus position with buttocks at/over the edge of the couch
• Couch then raised to comfortable level for the physician to perform the examination
• PR performed - ensures there is no obstruction to the scope as it is passed
• The sigmoidoscope must be lubricated prior to insertion either with water or lubricating jelly
• Tip of the obturator and scope is then passed in to the anal canal in the direction of the umbilicus
• Once the scope has passed through the anal canal the obturator is removed and the eyepiece secured
• The bellows are used at this stage and the scope is only advanced when the lumen can be visualised to ensure safe progression of the scope
• The goal is to visualise the rectum to the recto-sigmoid junction (15-17cm from the anal verge)
• However the procedure may not be completed due to
  • faecal loading and therefore poor visualisation
  • Pain experienced by the patient
• Biopsies can taken for histology
• As the scope is withdrawn it is essential to view the mucosa
• The exact technique applies for proctoscopy except banding of haemorrhoids may be performed using the proctoscope