Retroperitoneal emphysema after colonoscopic polypectomy.
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Although previously described and advocated, rectal retroflexion has not been well studied as a diagnostic maneuver. We report 75 cases in which the maneuver was performed during colonoscopy or fibersigmoidoscopy. The technique was both easily performed by the examiner and well tolerated by patients. Rectal retroflexion increased diagnostic yield in six of 75 patients. It proved a useful adjunct to the standard forward-view of the rectum in the evaluation of internal hemorrhoids and in the detection of small perirectal polyps and rectal inflammatory bowel disease. Excluding patients with severe proctitis or a contracted rectal vault, rectal retroflexion is a valuable technique for the evaluation of suspected rectal disease.
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By fibrocolonoscopy, fibrocolonoscopic biopsy, polypectomy, operation resp., one hundred and eight true polypi in the colon of 75 patients were studied, grouped according to localization: in caecum -- 2.8 per cent, in ascending colon -- II. I per cent, transverse colon -- 13.9 per cent, descending colon -- 19.4 per cent, in sigmoid colon -- 40.8 per cent and in rectum -- 12 per cent. Endoscopically they were grouped as follows: adenomatous -- 91.7 per cent and villous -- 8.3 per cent and after the pathohistological examination as: adenomatous 73.3 per cent, adenovillous -- 17.2 per cent and villous -- 9.5 per cent. In 40 (52.8%) of the cases, well differentiated polypi were concerned (I grade); in 30 (38%) -- moderately differentiated polypi (II grade) and in 5 (6.5%) -- poorly differentiated polypi (III grade). The studies revealed that the pathohistological examination was a method, specifying the morphological structure of polypus, determining the therapeutic behaviour of the clinicists. Fibrocolonoscopic polyrectomy solves the problem of diagnostics and treatment of the true polypi, contributing to the prophylaxis of colon carcinoma.
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The techniques of biopsy and polypectomy are essential skills for a primary care endoscopist because lesions requiring these interventions are common. This article reviews common and uncommon lesions, electrosurgical principles, traditional, and novel techniques.
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Between 1974 and 1992, we perform 3,054 colonoscopies for diagnosis in 2,770 patients, both of sexes, between the ages of 1 and 101 yr, most of them over the fifth decade of life. In 300 procedures the bowel cleansing was made with the standard method of liquid diet and enemas, and in the other 2,754 with the oral administration of saline solution 9% with optimal results. We get the sedation of patients with the intravenous administration of diazepam 10mg, or pethidine 50 mg, or midazolam 2.5 to 5 mg, and in children with ketamine and the anesthesiologist assistance. In 95% of the procedures we can see the cecum and the ileum; the diagnosis was abnormal in 52.78% of cases, normal in 45.20%, and insufficient in 02.02% specially for a bad cleansing of the bowel. In the abnormal group, the most frequent diseases we diagnose were: polyps, cancer, diverticular disease, and specific inflammatory disease of the bowel like TBC, radiation proctosigmoiditis, amebiasis, and non-specific bowel disease: "colitis", ulcerative proctocolitis, erosive colitis, and Crohn's disease. Colonoscopy is a very important method for diagnosis of colon diseases, alone or complementary of double contrast X-ray of the colon.
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