Procedure: Colonoscopy to the splenic flexure.
Indications: The patient is a 67-year-old female who recently developed bloating. She underwent an evaluation and was found to have ascites with caking of her omentum. She had a paracentesis done with cytology that revealed adenocarcinoma consistent with ovarian primary. She has been referred and scheduled for surgery, although they would like us to make sure there was not another source for her tumor. She denies nausea or vomiting. She does have a lot of indigestion. She denies dysphagia. With her recent ascites, her bowels have been moving less frequently. She has some rectal bleeding. She blames on hemorrhoids.
Description of procedure: The Patient was placed in the left lateral decubitus position. On initial perianal exam, she had prominent hemorrhoids with an overlying ulceration. These were not malignant, but just inflamed. The endoscope was inserted and advanced to approximately the distal transverse colon. I could not advance it further.
The prep was good.
I was able to advance the endoscope to approximately 80cm (shortened). The anatomy was extremely difficult, althought it looked like we were somewhere around the splenic flexure. We moved the patient into multiple different postions and applied pressure to her abdomen, but could not advance further because the colon was so tortuous. As the endoscope was withdrawn, she again was noted to have an extremely tortuous colon. It was very stiff. She was noted to have diverticulosis in the sigmoid colon. She had prolapsing hemorrhoids noted in the rectum.
Assessment:
1. Rectal bleeding due to hemorrhoids.
2. Diverticulosis.
3. Incomplete colonoscopy because of the tortuous colon, likely as a consequence of her intra-abdominal tumor and a baseline tortuous anatomy.
The doctor said this was discontinued because he did not advance all the way to the cecum. But I know for a discontinued colon you cannot pass the splenic flexure(Which the splenic flexure is at 54cm).
Thanks in advance for your insight.
Indications: The patient is a 67-year-old female who recently developed bloating. She underwent an evaluation and was found to have ascites with caking of her omentum. She had a paracentesis done with cytology that revealed adenocarcinoma consistent with ovarian primary. She has been referred and scheduled for surgery, although they would like us to make sure there was not another source for her tumor. She denies nausea or vomiting. She does have a lot of indigestion. She denies dysphagia. With her recent ascites, her bowels have been moving less frequently. She has some rectal bleeding. She blames on hemorrhoids.
Description of procedure: The Patient was placed in the left lateral decubitus position. On initial perianal exam, she had prominent hemorrhoids with an overlying ulceration. These were not malignant, but just inflamed. The endoscope was inserted and advanced to approximately the distal transverse colon. I could not advance it further.
The prep was good.
I was able to advance the endoscope to approximately 80cm (shortened). The anatomy was extremely difficult, althought it looked like we were somewhere around the splenic flexure. We moved the patient into multiple different postions and applied pressure to her abdomen, but could not advance further because the colon was so tortuous. As the endoscope was withdrawn, she again was noted to have an extremely tortuous colon. It was very stiff. She was noted to have diverticulosis in the sigmoid colon. She had prolapsing hemorrhoids noted in the rectum.
Assessment:
1. Rectal bleeding due to hemorrhoids.
2. Diverticulosis.
3. Incomplete colonoscopy because of the tortuous colon, likely as a consequence of her intra-abdominal tumor and a baseline tortuous anatomy.
The doctor said this was discontinued because he did not advance all the way to the cecum. But I know for a discontinued colon you cannot pass the splenic flexure(Which the splenic flexure is at 54cm).
Thanks in advance for your insight.
