Sigmoidoscopy

the rectoscope
Fig. 1. The rectoscope: top - R-50; at the bottom - R-60.
sigmoidoscopy
Fig. 2. Sigmoidoscopy: 1 - knee-elbow position in the study; 2-5 - phase introduction of proctoscope.

Sigmoidoscopy (synonym: proctosigmoidoscope, proctoscopy, rectoskopia) - endoscopic method of research of the mucous membrane of rectum and sigmoid colon. Using proctoscope, is a hollow metal cylinder that contains a metal rod (Fig. 1). Tube with the rod enter in a direct gut at the knee-elbow position of the patient. After that the rod is removed and inserted instead lighting device. Inspection of the mucous membrane of converging at a depth of 30 cm from the anus.
1-2 hours before the introduction of proctoscope purify the lower part of the colon with an enema. If the patient has diarrheathat impede the examination of the intestinal mucosa, the hour before the study give him 8-10 drops of tincture opium. Tube previously subjected to boiling, then smeared with vaseline and enter the rotational motion into the rectum according to its anatomical the go - first horizontally, and then send some back to the sacrum (Fig. 2).
Normal mucosa of rectum and sigmoid colon dark pink colour, wet, shiny surface. In pathological processes, you can see the swelling of the mucous membrane, ulceration, bleeding, tumors.
Sigmoidoscopy, conducted periodically, is considered one of the most reliable methods of timely detection of tumors of rectum and sigmoid colon.
Sigmoidoscopy in children is as a diagnostic study suspicious polyps, ulcers, rarely swelling of rectum, in the allocation of blood through the anus, constipation unclear etiology, having suffered from dysentery or colitis for monitoring the condition of the mucosa. In older children a sigmoidoscopy produce without anesthesia, the youngest is under General anesthesia (in the hospital and polyclinic), using child proctoscope. The intestines clean high enemas night before and the day of the examination. A sigmoidoscopy is usually in the patient on the back. Tube proctoscope, pre-grated alcohol, smeared with vaseline and injected slowly, without violence. Inspection is facilitated by the introduction in the gut air with balloon Richardson, connected to the tube proctoscope. Unmodified mucous membrane ulcers pink color, with transverse folds, not bleeding. Polyps of the small size can be detected only with careful study, shifting tube proctoscope not only in length but also in vertical and horizontal direction, while spreading out the folds of mucous membrane. In pathological enlargement and lengthening of the colon, you must consider her curves.

Sigmoidoscopy (from lat. rectum - rectum, S-romanum - sigmoid colon, and Greek. skopeo - examine; synonym: proctosigmoidoscope, rectoskopia, proctoscopy) - examination of mucous membrane of the rectum and sigmoid colon through the rectum. Apply rectoromanoscopy R-50 and R-60 (Fig. 1) the Leningrad factory "red guard". Rectoromanoscopy research precedes the preparation of the patient and tools.
Preparation of the patient is to release the lower intestine from faeces cleansing enema 2-3 hours before the study. For constipation may need additional enema or a laxative the night before. Diarrhea shortly before the study is given opium or (and) is a small cleansing enema. Before you study rectoromanoscopy assembled, transformer with a rheostat, and other useful tools must be placed on the table near the inquirer.
The position of the patient during the study is of great importance. The most favourable is the knee-elbow position (Fig. 2, 1), as such
the position is spontaneous pneumatic expansion of the rectal ampulla, straightening angle between it and pryamokishechnye part of the sigmoid colon, which greatly facilitates the introduction of endoscopic pipes and inspection of the mucosa. If for any reason (sharp weakness, the defeat of joints, diseases of the cardiovascular system and other) patient should not be given this position, the study produced on the right or on the left side (lateral position) with a raised pelvis and abdomen thighs. However, in this position endoscopy to produce more and already in the beginning it is usually necessary to resort to foment (insufflation) ulcer. Once the patient has taken the knee-elbow position, examining the anus and perianal area (external hemorrhoids, anal fissures, loss of mucous membrane, fistula and others) and as necessary produce digital examination of the rectum.
Indications for rectoromanoscopy very diverse: abnormal discharge from the intestines, tenesmus, discomfort in the rectum, persistent constipation, colitis, dysentery, hemorrhoids, suspected tumor. Contraindications to rectoromanoscopy: acute peritonitis, pronounced inflammation in the intestine and its surrounding tissues, severe General condition of the patient.

Fig. 1. Rectoromanoscopy: top R-50, below P-60.
Fig. 2. The knee-elbow position (I)phase of the introduction of rectoromanoscopy (2 - 5).
Fig. 3. Scheme of longitudinal and transverse sections of the rectum and pryamokishechnye part of the sigmoid colon and endoscopic picture: 1 - anus; 2 - m. sphincter ani ext.; 3 - m. sphincter ani int.; 4 - pars sphincterica (a - interna; b - externa); 5 - plica coccygea et plica sacralis int.; 6 - plica terminalis; 7 - rugae flexurae; 8 - plica labialis.

The technique of rectoromanoscopy. Tube with obturator, slightly warmed and on the ventral end greased with vaseline, rotary motions introduced into the anal canal on 4-5 cm in the horizontal direction (Fig. 2, 2, the first phase of the introduction). After that obturator removed from the tube, include lighting (light bulb), dorsal tube close the eyepiece or magnifying glass and thus further promote rectoromanoscopy do when lit field of view under the control of the eyes. For inspection of the mucous membrane of the rectal ampulla tube moves forward and slightly upwards (Fig. 2, 3; the second phase), and in process of approach to the sigmoid colon (11-13 cm from the anus) again gradually transferred to the horizontal position (Fig. 2, 4; the third phase). The entrance into the sigmoid colon often find not immediately; to find it, should be done by the end of the tube careful movements in different directions.
If this does not lead to the goal, then the receiver slightly output, and the patient is asked to breathe deeply, resulting entry in the sigmoid colon sometimes starts rhythmically, respectively respiratory movements, to open and close. In some cases the selection of the sigmoid colon gas, mucus or residues liquid contents can specify the location where it should be directed tube. More often than not have to resort to careful foment cancer that usually leads to the disclosure of entrance into the sigmoid colon. Promotion in her tube is made at an angle downwards (Fig. 2, 5; the fourth phase). Unlike rectoscopy, sigmoidoscopy always needs insufflation, which should produce an inquirer, not an assistant. Due insufflation folds of mucous membrane are smoothed, the bowel lumen expands and thus facilitated the promotion of pipes and inspection of the mucosa. Before the introduction of the method insufflation the mucous membrane of the sigmoid colon was inaccessible for inspection. However, insufflation method should not be abused. After the tube is introduced at the maximum possible depth (30-35 cm), take it slowly back and at the same time produce a more thorough inspection. The anal canal examined only on the way back, since the introduction of tube passes through it closed obturator. For a detailed study of the anal canal is better to use anoscope.
After each study tube and the rod sterilized, wipe with alcohol and dried. Boiling of emoderately not desirable, you can just wiping them with alcohol.

sigmoidoscopy
Fig. 1 - 6. Endoscopic picture at different levels of normal intestine. Fig. 1. The area of the rectal sphincter. Fig. 2. Rectal folds PC and lower sacred. Fig. 3 and 4. The entrance into the sigmoid colon, rectosigmoid fold. Fig. 5. The folds of the sigmoid colon. Fig. 6. Golovina fold - limit endoscopy. Fig. 7 - 12. View of the mucous membrane under some pathological States. Fig. 7. Inflammatory hyperemia and point bleeding on the PC fold. Fig. 8. Small erosion and bleeding on the PC and lower sacred folds. Fig. 9. Two shallow pojavilsia sores in the upper part of the rectum. Fig. 10. Ulcer with ragged edges, covered with fibrinous-purulent bloom in the sigmoid colon. Fig. 11. Follicular sores in the sigmoid colon. Fig. 12. Atrophy of the mucous membrane of the sigmoid colon.


Normal endoscopic picture at different levels of gut (Fig. 3 and printing. table, Fig. 1-6). When rectoromanoscopy entered on 5-6 cm visible ampulla of the rectum with exposed in its clearance large transverse folds. Such permanent rectal folds are usually two-three and more rarely. Lower PC fold is at a distance of 6-8 cm from the anus. At the same time be seen and second - bottom of the sacred fold, located somewhat higher PC and how would intersecting with it at a sharp angle. Quite often there is a third fold smaller - top sacred. At a distance of 11-13 cm from the anus, i.e., on the border between the rectum and the sigmoid colon, you can sometimes see the pronounced so-called rectosigmoidoscopy (terminal) fold.
In other cases, the entry in the sigmoid colon on the mind has some similarities with the shutter tobacco pouch, with mitral valve, with the mouth of the uterus and other Sigmoid endoscopically sharply differs from direct its narrow lumen, sadauskis pliable walls, tender easily antialiasing circular folds. At a distance of about 20 cm from the anus to posterolateral the wall of the intestine is usually clearly visible ripple iliac artery. On depth 30-35 cm, which is the limit of endoscopy, one can see the so-called gobowen crease formed by the natural bend of the sigmoid colon. Slimy anal canal (3-4 cm) forms 8-10 longitudinal, short, distal growing wrinkles, anal columns (columnae anales), between which there are open at the bottom upwards small pockets (sinus anales). Endoscopically these folds are represented as small blisters, pyramids, which surround the tube. Normal mucosa rectum and sigmoid colon dark pink colour, wet, shiny surface; in the anal canal it is somewhat brighter.
Endoscopic picture at pathological conditions - see printing. table, Fig. 7-12.