Question

Colonoscopy Report:  The patient is a 73-year-old woman who underwent colonoscopy and polypectomy on June 10, 2007. Biopsy revealed an invasive carcinoma, and on June 12, 2007, she underwent a low anterior resection and coloproctostomy. Fourteen months later, on August 2, 2008, she was seen in the office for flexible sigmoidoscopy, and a polyp was detected. Colonoscopy was scheduled.

Description of Procedure: The fiberoptic colonoscope was introduced, and I could pass it to about 15 cm, at which point an anastomosis was apparent. The colonoscope passed easily through a wide-open anastomosis to 30 cm, at which point a very friable [easily crumbled] polyp, irregular, on a short little stalk, was encountered. This was snared, the coagulating [blood-clotting] current was applied, and the pedicle [stalk of the polyp] was severed and recovered and was sent with the polyp to Pathology for histologic identification. I continued to advance the colonoscope through the descending colon through the splenic flexure and into the transverse colon. Despite vigorous mechanical bowel preparation and the shortened colon from the previous resection, a considerable amount of stool was still present within the bowel. At the hepatic flexure, I abandoned further evaluation because of difficulty in visualization and began to withdraw the colonoscope. The colonoscope passed through the transverse colon, splenic flexure, descending colon, sigmoid colon, rectum, and a**nus and was withdrawn. She tolerated the procedure well, but had some nausea. I will await the results of pathology, and in the event that it is not an invasive carcinoma, I would recommend a repeat colonoscopy in 6 months, at which time we will use a 48-hour, more vigorous mechanical bowel preparation.

1. Using the scenario above, answer the following questions:
   • On June 10th, what was the initial procedure that the patient underwent?
   • On June 12th, what additional surgery did the patient have?
   • Which term in the report refers to an anatomosis?
   • Why was it impossible to visualize the entire colon?

Answer 1

1. Initial procedure on June 10th:

The patient undergone the initial procedures on June 10, 2007. The initial procedure that the patient underwent is  

* Colonoscopy : The examination of the Colon using a Colonoscope is called a Colonoscopy . Colonoscope is a flexible fibreoptic endoscope used to examine the colon and obtain tissue samples. This long flexible tube is inserted into the rectum and video camera at the tip of the tube allows the interior visualization by the Doctor.

Colonoscopy procedure was followed by the procedure:

* Polypectomy: The removal of a Polyp, an abnormal growth protruding from a mucous membrane .

2. Additional surgery: The patient underwent an additional surgery of ;

Low anterior resection with Coloproctostomy:

Resection is the surgical excision of part or all of a tissue or organ . Low anterior resection( LAR) is a surgery to treat rectal or colon cancer, in which a part of rectum or colon will be removed along with the cancer tissue and the remaining part will be reconnected each other.

Coloproctostmy : Anastomosis of the colon to the rectum or surgical joining of the remaining part of colon to the rectum is called Coloproctostmy.  

3. The term that refers to an ' anastomosis ' is Coloproctostmy, an anastomosis between colon and rectum . Anastomosis is a surgical creation of a connecting passage between blood vessels, bowels or other channels.

4. Presence of a considerable amount of stool in the bowel, even after the thorough bowel preparation, made the visualization of remaining colon impossible and the reduction in the length of the colon due to previous surgery also made the task difficult.