0000000000012932
AUTHOR
Peter Otto
Indikationen zur proktologischen Untersuchung und Endoskopie des Dickdarms
Das Colon ist ein oligo-symptomatisches Organ. Es reagiert auf unterschiedliche Noxen mit folgenden Symptomen: Schmerzen — Tenesmen; Obstipation/Diarrhoe; Abgang von Blut und Schleim.
Fistulae (Rectovaginal, Rectovesical)
The clinical manifestations of a fistula — stool from the vagina, air from the urethra — are often difficult to recognize because the fistulous opening is hidden by the edematous and swollen mucosa. Larger defects occur particularly after radiation therapy and with Crohn’s disease.
Anwendungsbereiche proktologischer Untersuchungsverfahren
Mit Inspektion und digital-rectaler Tastuntersuchung kann man sich begnugen bei: 1. Vorsorgeuntersuchungen ohne Beschwerdeangaben und negativem Test auf okkultes Blut im Stuhl (Haemoccult-Test, Fa. Rohm Pharma/Darmstadt, hemo FEC, Boehringer/Mannheim) 2. Juckreiz, Nassen, Feuchten in der Rima ani.
Inspection of the Perianal Region
During inspection of the perianal region and the anus, a portion of the anal canal may also be examined through stretching of the buttocks (Fig. 13). Good illumination is needed for an optimal examination.
Anastomoses (Ileorectal; Colorectal)
With disease processes that involve the large bowel but leave the rectum free (Crohn’s disease, diverticulitis, neoplasms), a surgical procedure used for their treatment will result in an anastomosis that may be seen during rectoscopy. During the postoperative follow-up period, careful attention should be given to any recurrence, which in cases of Crohn’s disease is seen very early on rectoscopy.
Anitis — Cryptitis — Papillitis
Inflammatory processes within this transitional zone cannot be separated from one another and often occur together. The source of the infection will usually be found in the crypts of Morgagni, originating in the dorsal crypts and spreading to the adjacent papillae. The area of involvement appears erythematous and edematous, and pus occasionally exudes from the crypts. An association exists between cryptitis and the development of anal fissures, and between anal fissures and hemorrhoidal diseases. The anal canal is for the most part also involved in the inflammatory process. One encounters an anitis, which because of an increased secretion produces a perianitis and perpetuates a perianal ecz…
Solitary Rectal Ulcer
Solitary ulcers of the rectum may be traumatic in origin and caused by thermometers, occasionally by digital removal of a fecal impaction, or by deviate sexual behavior. Solitary rectal ulcers may also be a manifestation of Crohn’s disease. Very rarely, ectopic gastric mucosa is their cause. For the vast majority of solitary rectal ulcers, the explanation remains unknown. Occasionally, the ulcers are accompanied by localized inflammation of the mucosa within the distal segment of the rectum with edema, erythema, and circumscribed whitish flecks in a thickened bowel wall covered by excessive secretions. The changes are found predominantly in the ventral portion of the rectum, and in contrast…
Preparation for Endoscopic Examination
Inspection of the perianal area, the digital rectal examination, and the proctoscopic examination may be done without special preparation.
Digital Rectal Examination (Fig. 2a and 2b)
During examination of the anal region and before doing the rectal examination, the hand is protected by a plastic glove. A number of disposable gloves of varying strengths are on the market. One may additionally use a finger cot on the forefinger, which is removed after the examination. The examination can also be done using a finger cot alone with the finger stuck through a piece of gauze that protects the rest of the hand. Right-handed examiners often elect to use the forefinger of the left hand for the rectal examination and keep the right hand uncontaminated for handling instruments.
Technique for Performing Rectoscopy
After positioning of the patient (Figs. 1 and 11), the instrument is introduced into the anus. The anal canal runs diagonally toward the navel. This distance must be passed blindly. The instrument is therefore guided through this area with the help of the obturator, which is promptly removed after passage of the instrument through the anal canal.
Diseases of the External Anal Area
Diseases of the external anal area may be diagnosed during inspection using good lighting. Because of the variable responses to treatment, the individual diseases should be diagnostically distinguished from one another.
Instruments Used for Endoscopy of Anus and Rectum
In the discussion of endoscopic instruments and additional tools, we have referred only to the general features and important principles since instruments from individual firms not only vary in details but are also being continuously modified. The characteristics of any specific instrument may be obtained from its manufacturer.
Inflammatory Bowel Diseases
The endoscopic aspects of an inflammatory colon disease do not permit the differentiation of a nonspecific proctitis from a bacterial enterocolitis and an ulcerative proctitis.
Indications for Performing a Proctologic Examination and Endoscopy
Complaints from the patient about discomfort in the anal region, rectal bleeding, and change in bowel habits — especially recent occurrence of constipation or diarrhea or a change in either symptom — as well as tenesmus are obligatory reasons for conducting a proctologic examination. These symptoms should never be ignored or treated by prescription of hemorrhoid suppositories, antispasmodics, analgesics, or laxatives.