Atlas of Rectoscopy and Coloscopy

The first portion of this work is devoted to a consideration of the practical aspects of the proctoscopic examination and thus presents the indications for performing a proctologic evaluation, the information that may be obtained from the patient's medical history, an example of a preprinted data form for use in the recording of the physician's findings, the preparation and positioning of the patient, and the preliminary examination of the anus including the digital rectal examination. The instruments needed to perform proctoscopy are uncomplicated, and the basic tools are inexpensive. The instruments currently available do not really differ from each other except in minor details. In the text, therefore, we have only described the prototype instruments, and details about the pro­ posed advantages of any particular instrument can be obtained from its manufac­ turer. The concluding portion of the text describes how the proctoscopic and colonoscopic examinations are performed. The atlas itself is a topographical stratification of the various diseases that may involve the perianal region, the anus, and the adjacent portions of the large bowel as well as their classification according to morphologic criteria, for example, inflammatory bowel diseases and tumors. Since many pathologic findings in the rectum and sigmoid colon are comparable to those in the upper portions of the large bowel, a duplication of these proctoscopic and colonoscopic illustrations has been avoided.

1 Introduction.- 2 Indications for Performing a Proctologic Examination and Endoscopy.- 3 Clinical History.- 3.1 Preprinted Record Form.- 4 Preparation for Endoscopic Examination.- 4.1 Proctosigmoidoscopy.- 4.2 Sigmoidocolonoscopy.- 4.2.1 Extended Sigmoidoscopy.- 4.2.2 High Colonoscopy.- 4.3 Endoscopic Polypectomy.- 4.4 Premedication for Sigmoidocolonoscopy.- 5 Position.- 5.1 Knee-Elbow or Knee-Chest Position.- 5.2 Dorsal Lithotomy Position.- 5.3 Sims’s Position.- 6 Inspection of the Perianal Region.- 7 Digital Rectal Examination.- 7.1 Finger Protection.- 7.2 Practical Performance.- 8 Instruments Used for Endoscopy of Anus and Rectum.- 8.1 Lighting.- 8.2 Anal Specula.- 8.3 Anoscope.- 8.4 Proctoscope.- 8.4.1 Instruments with Anterior Opening.- 8.4.2 Instruments with Lateral Opening.- 8.5 Rectoscope.- 8.6 Pediatric Instruments.- 9 Additional Instruments.- 9.1 Sounds.- 9.2 Cleaning Aids.- 9.2.1 Applicators.- 9.2.2 Suction Tubes.- 9.2.3 Suction-Irrigation Devices.- 9.3 Biopsy Instruments.- 9.3.1 Forceps.- 9.3.2 Suction Biopsy.- 9.4 Polyp Snares.- 9.5 Coagulation Sounds to Control Bleeding.- 9.6 Curved Knife.- 9.7 Foreign-Body Forceps.- 9.8 Instruments for Treatment of Hemorrhoids.- 9.9 Optical Aids.- 9.9.1 Magnifiers.- 9.9.2 Magnification Attachments (Lumina, Hopkin’s Optics).- 9.10 Documentation by Photography.- 10 Technique for Performing Rectoscopy.- 10.1 Introduction of the Instrument.- 10.2 Manipulation of the Instrument During Its Advancement.- 10.3 Normal Findings.- 10.4 Factitial Lesions due to Patient Preparation and Examination.- 10.5 Incidental Findings.- 10.5.1 Melanosis Coli.- 10.5.2 Colica Mucosa (“Mucus Colitis”).- 10.6 Biopsy.- 10.6.1 Forceps Biopsy.- 10.6.2 Suction Biopsy.- 10.7 Complications.- 10.7.1 Perforation.- 10.7.2 Bleeding.- 10.8 Removal of Polypoid Lesions.- 11 Colonoscopy.- 11.1 Endoscopic Instruments.- 11.2 Additional Instruments.- 11.3 Examination Technique.- 11.4 Polypectomy.- 11.4.1 Technique of Polypectomy.- 11.5 Complications.- 11.5.1 Sigmoidocolonoscopy.- 11.5.2 Polypectomy.- 12 Diseases of the External Anal Area.- 12.1 Eczema.- 12.2 Hemorrhoidal Tags.- 12.3 Perianal Thrombosis (“Hematoma”).- 12.4 External Hemorrhoids.- 12.5 Anal Fissure.- 12.5.1 Acute Fissure.- 12.5.2 Chronic Fissure.- 12.6 Condylomata.- 12.6.1 Pointed Condylomata (Condylomata Acuminata)..- 12.6.2 Broad Condylomata (Condylomata Lata)…..- 12.7 Anal Fistula.- 12.8 Incomplete Fistula.- 12.9 Anal Carcinoma.- 12.10 Anal and Rectal Prolapse.- 13 Anitis ― Cryptitis ― Papillitis.- 14 Hemorrhoids.- 14.1 Staging.- 14.2 Treatment.- 15 Inflammatory Bowel Diseases.- 15.1 Nonspecific Proctitis.- 15.2 Infectious (Entero-) Proctocolitis.- 15.3 Radiation Proctitis.- 15.4 Ischemic Colitis ― Pseudomembranous Colitis.- 15.5 Ulcerative Colitis.- 15.5.1 Hemorrhagic (“Ulcerative”) Proctitis.- 15.5.2 Active Ulcerative Colitis.- 15.5.3 Chronic Ulcerative Colitis.- 15.6 Crohn’s Disease.- 16 Parasites.- 17 Diverticulosis ― Diverticulitis.- 18 Tumors.- 18.1 Benign Tumors.- 18.1.1 Hyperplastic Polyps.- 18.1.2 Tubular Adenoma ― Papillary Adenoma ― Villous Adenoma ― Mixed Forms.- 18.1.3 Familial Polyposis (Adenomatosis).- 18.1.4 Peutz-Jeghers Syndrome.- 18.2 Malignant Tumors.- 19 Endometriosis.- 20 Pneumatosis Cystoides Intestinalis.- 21 Solitary Rectal Ulcer.- 22 Anastomoses (Ileorectal, Colorectal.- 23 Fistulae (Rectovaginal, Rectovesical).- 24 Ureteral Transplantation.- 25 Melena.- 26 Foreign Bodies.- Plates I–XIX.- Plate I Endoscopic findings in normal rectum.- Plate II Melanosis recti, perianal eczema, hemorrhoidal tags.- Plate III Perianal thrombosis, external hemorrhoids.- Plate IV Anal fissure, condylomata.- Plate V Anal fistula.- Plate VI Anal carcinoma, anal and rectal prolapse.- Plate VII Anitis, cryptitis and proctitis.- Plate VIII Hemorrhoids and their treatment.- Plate IX Radiation proctitis.- Plate X Infectious entero-colitis, amebic colitis.- Plate XI Floride ulcerative colitis.- Plate XII Chronic ulcerative colitis, pseudopolyps.- Plate XIII Crohn’s disease.- Plate XIV Crohn’s disease, diverticulum.- Plate XV Polyps.- Plate XVI Polyps.- Plate XVII Polyposis.- Plate XVIII Carcinoma and other malignant new growths.- Plate XIX Solitary rectal ulcer, rectovesicle fistula, tarry stool in rectum.