Ректороманоскопия

The human intestine is part of the digestive tract. A huge number of processes take place in it that directly affect the entire process of the functioning of the human body. The main, but not the only function of the intestine is the digestion of food, the absorption of all useful elements, and the removal of processed products from the body. Violations in the structure or functioning of this section of the digestive tract are immediately manifested by weight loss, decreased immunity, general malaise, deterioration of the skin, nails, and hair. One of the endoscopic research methods is sigmoidoscopy (rectoscopy) – a visual diagnostic method that allows the doctor to directly examine the mucous walls of the rectum, and, if necessary, the cavity of the distal sigmoid colon.

What organs are examined during sigmoidoscopy

All sections of the intestine are located in the abdominal cavity. During life, the total length of the human intestine is 4 meters, after death – 6-8 meters. The shape, size and location of this organ changes throughout a person’s life, its length and diameter of the lumen increase.

Anatomically, the entire intestine is divided into two parts: thin and thick. The small intestine is represented by three subdivisions: the duodenum, jejunum, and ileum. Much of the digestion process takes place in this part of the digestive tract.

This section of the intestine got its name not by chance – firstly, it has thinner and less durable walls than the large intestine, and secondly, the diameter of its lumen is also smaller than the lumen of the large intestine.

The large intestine is the end of the digestive tract. In it, for the most part, the absorption of water and the formation of a lump of feces remaining after digestion is carried out. The name of this section of the digestive tract speaks for itself: its walls are thicker than the walls of the small intestine, due to the thicker layer of muscle and connective tissue, and the diameter of the cavity is wider than the diameter of the lumen of the small intestine.

The large intestine consists of the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum, ending in the anus.

The most important functions of these internal organs are:

• digestion of food: splitting it, including by hydrolysis using pancreatic enzymes, absorption of most nutrients from the food bolus;
• mixing and moving intestinal contents;
• absorption of water from intestinal contents;
• removal of formed feces from the body;
• participation in the metabolic process;
• synthesis of various types of hormones: secretin, pancreozymin, motilin, neurotensin and others;
• the production of immunoglobulins and T-lymphocytes – cells that are important for immune processes.

During rectoscopy, the rectum is examined, as well as the distal sigmoid colon. The sigmoid colon is located between the colon and rectum. Anatomically, it begins at the level of the upper aperture of the small pelvis, then it is located transversely to the right in front of the sacrum, bends to the left and continues down, where it passes into the rectum. It is named sigmoid for its S-shape.

In the pelvic area is the rectum, in which feces accumulate. It really has a straight shape, without bends and turns. The part of the rectum that is directly adjacent to the anus is called the anus. It has a narrower diameter. Above it is the ampullar part of the rectum. The distal part of the sigmoid colon is located above the ampulla of the rectum.

What is sigmoidoscopy

Rectoscopy is a technique for endoscopic examination of the lower intestine using a special apparatus – a sigmoidoscope. This type of endoscope has the form of a hollow tube equipped with an air supply and a light source. A sigmoidoscope usually comes with several tubes of various sizes. To examine the mucous walls of the intestines, specialized optics are offered for the device. The procedure can be carried out with a device with a rigid or flexible tube.

This method of examination is accurate and effective, since the doctor has the opportunity to directly examine the parts of the intestinal mucosa that are of interest to him. It is quite often prescribed as a general proctological examination. The diagnostic procedure using a sigmoidoscope provides an opportunity to visually assess the condition of the lower intestine at a distance of 35-40 centimeters from the anus.

In addition to examination, this type of endoscope allows the doctor to perform some medical manipulations and minimally invasive surgical interventions:

• take tissue samples for biopsy;
• remove polyps;
• cauterize neoplasms;
• remove foreign objects;
• coagulate blood vessels during bleeding.

Indications for sigmoidoscopy are:

• pain in the anorectal region;
• stool disorders: constipation, alternating with diarrhea;
• problems with the process of defecation;
• signs of hemorrhoids, bleeding from the intestines;
• atypical discharge from the anus (in the form of pus, mucus);
• suspicion of the presence of neoplasms;
• foreign body sensation;
• inflammatory bowel disease, chronic hemorrhoids;
• carrying out preventive measures for patients older than 40 years;
• clarification of the primary diagnosis, identification of grounds for surgical intervention, monitoring the effectiveness of the treatment.

Who should not be given the procedure

Before referring the patient for rectoscopy, the attending physician (therapist, oncologist, proctologist) must find out from him the presence of contraindications, if necessary, refer the patient to an appointment with medical colleagues in other areas, or to pass clarifying tests.

Contraindications to the appointment:

• the presence of bleeding from the rectum;
• acute anal fissure;
• a general serious condition, for example, if the patient is connected to life support devices;
• narrowing of the diameter of the intestinal lumen;
• acute inflammatory process in the abdominal cavity, peritonitis;
• pulmonary and heart failure;
• acute paraproctitis: purulent inflammation of the tissues around the rectum;
• some mental disorders.

In such cases, endoscopic examination should be postponed until the end of the course of conservative therapy aimed at improving the patient’s condition.

Preparing the patient for the study

The specificity of the procedure explains the existence of special training requirements. The patient two days before the appointed date begins to follow all the rules prescribed by the doctor. The whole point of the preparation is to clear the examined intestine from feces, as they interfere with the examination. For this, the subject is prescribed a special slag-free diet. All consumed products should be easily digestible and not contain coarse dietary fiber. 2-3 days before the date of the procedure, you need to exclude from the menu:

• potatoes, pasta and pearl barley;
• fatty fish and meat;
• beans;
• black bread, rich confectionery;
• chocolate;
• nuts;
• seasonings, spices, spices;
• coffee, strong tea, alcohol, carbonated drinks, kvass, concentrated juices;
• whole milk products.

As part of preparing the patient for examination, the diet should consist of lean fish and meat, boiled or steamed, vegetable broths and broths, low-fat dairy products, weak green or herbal tea, clear juices. All physical activity during this time should be kept to a minimum.

An approximate diet before sigmoidoscopy looks like this: two or three days before the procedure, it is allowed to eat buckwheat or oatmeal on water for breakfast, white bread toast with low-fat cheese, a glass of tea. An hour and a half before lunch, the patient drinks a glass of low-fat kefir. For lunch, you can cook a weak broth from lean meat, a few meatballs from veal or turkey, or bake lean fish and eat it with a small portion of boiled rice, washed down with a glass of clarified apple juice. As an afternoon snack, a low-fat cottage cheese casserole or a glass of low-fat yogurt is allowed. Dinner should be very light – for example, semolina porridge on the water or a few pieces of biscuit cookies with a glass of fermented baked milk.

On the day immediately before sigmoidoscopy, it is necessary to prepare the intestines with the lightest possible food: for breakfast, 1 soft-boiled egg, white bread toast with low-fat cheese, a glass of tea are offered; Dinner on this day is no longer possible. Before nightfall, you need to prepare to cleanse the intestines from feces.

There are two cleaning methods:

• mechanical;
• medical.

For the first, you can use Esmarch’s mug. Washing should be carried out the night before, and in the morning immediately before the procedure. Two hours before the enema, you should take 150 milliliters of magnesium sulfate or a few tablespoons of castor oil.

During the procedure, the person lies on the left side with legs bent at the knees. For the process, you will need one and a half liters of boiled clean water at room temperature. The mug is suspended at a certain height, air is released from the hose, the tip is inserted into the anus. The water pressure is regulated by a special tap on the hose. To prevent air from entering, some water should remain in Esmarch’s mug. The entire injected volume of liquid must be held for 7-10 minutes.

With successful preparation, a clear liquid comes out after washing. The method is prohibited for hemorrhoids, ulcers and cracks.

Medicamentous cleansing methods make it possible to gently cleanse the intestines at home, without disturbing the microflora of the organ. You can take any of the drugs to choose from:

• Fortrans;
• Flit-phospho-soda;
• Lavakol;
• Mikrolax;
• Dufalac.

Before taking any of the drugs, it is necessary to consult with the doctor who will conduct the examination, as the drugs have features of use and contraindications.

How is sigmoidoscopy performed?

Before proceeding with the examination of the intestine, the doctor conducts a survey of the patient, and a mandatory digital examination of the rectum. The patient is explained the technique of the procedure, warned about the possible appearance of the urge to empty the intestines, as well as various uncomfortable sensations. Unpleasant manifestations appear due to the supply of air into the intestine. Spasmodic contractions may also appear. All that is required of the subject at these moments is to breathe slowly and deeply, to focus precisely on breathing. The doctor talks about all this before the start of the examination.

The patient undresses below the waist and takes the appropriate position on the examination table – knee-elbow, or lying on the left side with legs bent at the knees. Doctors say that the first option is more preferable, since in this case the endoscope passes more easily from the rectum to the sigmoid.

The tube of the apparatus is lubricated with petroleum jelly, after which the doctor inserts it into the anus 4-5 centimeters deep. After that, the subject needs to strain, as during a bowel movement – at this moment, the diagnostician inserts the tube even deeper. The obturator covering the distal end of the tube is removed, and special optics are inserted into the device. With its help, the doctor conducts a visual examination of the mucous membranes, gradually moving the tube forward or backward, and also gently tilting it so as not to injure the intestinal walls. In this case, there is a gradual pumping of air into the intestine through the tube – this allows you to straighten the folds of the intestine.

If the bowel cleansing is not carried out thoroughly enough, and the remnants of intestinal contents interfere with the review, the device is removed, the excess is removed with a sterile swab, after which the procedure starts all over again. If there is blood, pus, mucus in the intestine, they are pumped out with a special electric pump. The doctor removes polyps by inserting a special coagulation loop into the intestine through the tube of the device. She cuts off the neoplasm, after which it is removed from the intestine and sent for histological examination. Such manipulations can be carried out with anesthesia. The patient is given local anesthesia, after which they proceed to remove the formation.

After completion of the visual examination and all invasive procedures, the device is slowly removed from the bowel.

Examination procedure for children and pregnant women

The requirements for preparing a child for sigmoidoscopy are identical to the algorithm for preparing adults. Diagnostic examination of the rectum and sigmoid colon for children of primary school age is performed under general anesthesia. Sigmoidoscopes designed for small patients are smaller. With narrowing of the anus, peritonitis and inflammatory changes in the anus, the procedure is not prescribed.

Sigmoidoscopy in pregnant women is allowed only during the first trimester, if it is approved by a gynecologist, endoscopist and gastroenterologist. Together, these specialists decide whether the benefit to the mother outweighs the potential threat to the fetus, and whether it is appropriate in a particular case.

Results of the survey

What does a rectoscopy show? What pathologies can be detected during its implementation? After the examination, the doctor-endoscopist proceeds to draw up a conclusion. During the procedure, the doctor can diagnose prostate adenoma in men, endometriosis of the rectum in women, ulcerative colitis, internal or external hemorrhoids, rectal fissures, acute or chronic paraproctitis, the presence of polyps or malignant tumors, anal papilla proliferation, anal fistulas or anal-rectal abscess. He reflects all detected pathologies in the conclusion.

In the normal state, the mucosa of the sigmoid colon has a light pink or orange color, it contains pits and semicircular folds. The shell of the rectum is more pronounced red, as it has a developed network of blood vessels. Between the rectum and the anal canal, the mucosa is colored purple. The lower part of the anal canal is normally gray-brown in color.

The results of the study, issued in the form of a medical report of a diagnostician, the patient passes on to his attending physician, who sent him for rectoscopy.

The sigmoidoscopy procedure, along with colonoscopy, anoscopy, irrigoscopy, fibrocolonoscopy, is a method for examining the condition of various parts of the intestine. During its implementation, the doctor has the opportunity to visually assess the condition of the mucous tissues of the rectum and the distal sigmoid. Both of these intestines belong to the large intestine, are responsible for the absorption of water and the formation of feces. Sigmoidoscopy allows you to detect cracks, polyps, tumors, bleeding, hemorrhoids and other pathological conditions of these parts of the intestine, as well as immediately perform minimally invasive surgical procedures for their treatment.

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