Rigid sigmoidoscopy - Forum

User avatar
Old surgeon

Rigid sigmoidoscopy - Ärzteforum

Post#1 »

I'm fascinated by the concept that rigid proctoscopes are still being
used for diagnostic purposes. I guess I have been living in my own
little world, but do any other for-surgeons.com members use this venerable (if
somewhat medievil) piece of equipment?


User avatar
A Doctor

Re: Rigid sigmoidoscopy - Ärzteforum

Post#2 »

Yes.
If a patient presents with bleeding from bowel that has features
of colonic disease, then clearly colonoscopy or flexible sigmoidoscopy
is appropriate. If he has change of bowel habit, colonoscopy or even
Barium enema would be used. However if a young patient presents with
minor anorectal problems (e.g. piles) would you not think that a rigid
sigmoidoscopy a reasonable diagnostic aid? It will at least eliminate
idiopathic proctitis, solitary rectal ulcer syndrome, etc from
consideration. Sure one could do a flexible sigmoidoscopy, but a rigid
scope is quicker, and cheaper, and frankly I would prefer it (I have had
one)
I believe that rigid scopes are the norm in the UK for minor ano
rectal problems. Are we so very out of date?

User avatar
Alalo

Re: Rigid sigmoidoscopy - Ärzteforum

Post#3 »

Of course there is still a large role for rigid sigmoidoscope--wwatch
out for losing sight of the forest(i.e. real world) becuse of being
so caught up in your little world--there is nothing "medieval " about
it--also think of the lesser expense for the patient, if that means
anything to you. I actually only use it however when scoping on the
operating table under anesthesia for anorectal problems or prior to
low anterior resections--in the outpatient setting flex sig has
pretty much replaced rigid, mainly due to patient comfort
But still some exceptions--i.e. when we try to reduce a sigmoid
volvulus, the rigid scope I believe is the better way to go.

User avatar
Doctor Green

Re: Rigid sigmoidoscopy - Ärzteforum

Post#4 »

I have had experience in reducing 8 sigmoid volvulus(i?) over the last 4
years with a colonoscope. The ability to cross the twist with least trauma,
and suction the distended segment to untwist it with the colonoscope has
been most appreciated.
Actually I was unaware till now that a rigid sigmoidoscope could be used for
the volvulus.
How actually do you go about it? What do you believe are the benefits?

User avatar
A Doctor

Re: Rigid sigmoidoscopy - Ärzteforum

Post#5 »

I tried to make clear that I was talking about DIAGNOSTIC uses
of a rigid proctoscope. I have used one a few times over the years to
reduce sigmoid volvulus, but have come to feel that colonoscopy is a
better tool for that purpose. At least in my hands.

Perhaps I misread Michele's post, but I interpreted it to mean this
cancer at 18 cm was diagnosed by rigid proctoscope. Are you saying that
this patient didn't need colonoscopy? That rigid proctoscopy is
sufficient in cases of suspected colon cancer? Should we be doing
colonsocopy AND rigid proctoscopy for cases of colon cancer? I don't
think this is true, but I'd be interested to hear your opinion.

User avatar
Surgeon

Re: Rigid sigmoidoscopy - Ärzteforum

Post#6 »

I agree with you that colonsocopy or flex sig is theappropriate
means of colon evaluation in the presence of a cancer or for routine
screening--your post, however, said very clearly something to the
effect of "does anyone EVER use this medieval device anymore?"
I was simply answering--of course, yes!

canadian

Re: Rigid sigmoidoscopy - Ärzteforum

Post#7 »

No, of course rigid proctoscopy is insufficient for suspected
colon cancer - or indeed for suspected polyps.
How often will you colonoscope a patient who has had a colon
cancer or polyp, and is there a place for rigid proctoscopy in between
these colonoscopies in order to view a suture line for local recurrence?
Presumably we would all accept that there is a very small risk
of colon perforation with colonoscopy?

Hans

Re: Rigid sigmoidoscopy - Ärzteforum

Post#8 »

No, of course rigid proctoscopy is insufficient for suspected
colon cancer - or indeed for suspected polyps.
How often will you colonoscope a patient who has had a colon
cancer or polyp, and is there a place for rigid proctoscopy in between
these colonoscopies in order to view a suture line for local recurrence?
Presumably we would all accept that there is a very small risk
of colon perforation with colonoscopy?

Ron

Re: Rigid sigmoidoscopy - Ärzteforum

Post#9 »

I use two rigid instruments.
A short fat thing about 6cm long for examining the anorectal area which I
call a proctoscope - great for this, and for injecting/banding haemorrhoids,
and a longer slimmer thing about 25cm long which I call a sigmoidoscope -
although its really the rectum that one sees through this. This is very
good for rectal pathology - and for gauging the level of rectal cancers. It
works well for deflating sigmoid volvulus if one passes a flatus tube up
it - as the instrument itself in this instance will only get up to the recto
sigmoid junction. With our patients here I prefer to operate on them as
soon as possible as if successfully deflated they tend to disappear off
until the next episode - which may be a gangrenous volvulus. Both
instruments are robust, easily cleaned with a bucket and bottle brush, and
require no bowel prep usually. I see no good reason to make them redundant.

User avatar
Treatment guru

Re: Rigid sigmoidoscopy - Ärzteforum

Post#10 »

I agree with what others have mentioned as a role for
"Medieval Rigid Sigmoidoscopy"
In addition to:
- examining the rectum following a low anterior resection &
anastomosis intraoperatively
- examining the rectal stump preoperatively
- diagnosis and therapy of benign anorectal disease
- reducing sigmoid volvulus

I wish to add that it is quite convenient to do an immediate & quick
sigmoidoscopy in Emerg when I admit a lower GI bleed (usually this is
around midnight when the endoscopy suite is locked up tighter than Fort
Knox) to quickly rule out hemorrhoidal bleeding and low rectal
lacerations(from FLEET enemas, self-digital disimpaction, various small
rodents etc...) before proceeding with more definitive investigations
during daylight hours. I have often heard the horror stories of subtotal
colectomies for Lower GI bleeding, only to discover bleeding hemorrhoids
postop. Of course, I have never, ever seen this personally(...perhaps
because I ALWAYS do a quick sigmoid in Emerg and have not yet got
Burned)!

In short, I still think that there is a role for this simple, cheap and
well tolerated investigation to complement the other high-tech toys out
there.

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