45317 Proctosigmoidoscopy, rigid; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)

Name of the Procedure:

Proctosigmoidoscopy, rigid; with control of bleeding
Common name(s): Rigid Sigmoidoscopy with Hemostasis

Summary

Proctosigmoidoscopy is a medical procedure that involves the examination of the rectum and the lower part of the colon using a rigid tube called a sigmoidoscope. It also includes techniques to control bleeding within these areas, such as using injections or various types of cautery (heat-based techniques).

Purpose

The procedure is used to diagnose and treat bleeding in the rectum and lower colon. The goals are to identify the source of the bleeding, treat it effectively, and prevent further blood loss to avoid complications like anemia.

Indications

• Rectal bleeding
• Blood found in stool tests
• Suspected polyps or tumors
• Chronic diarrhea or constipation
• Unexplained abdominal pain

Preparation

• Fasting for several hours before the procedure.
• Bowel prep may be required, typically involving enemas or laxatives.
• Adjustments to certain medications, such as blood thinners.
• Pre-procedure diagnostic tests like blood work or imaging may be required.

Procedure Description

1. The patient is positioned on their side or back.
2. Anesthesia or sedation may be administered as needed.
3. The rigid sigmoidoscope is gently inserted into the rectum.
4. The physician inspects the rectum and lower colon through the scope.
5. If bleeding is found, it may be controlled using one or more of the following:
   • Injection of a sclerosing agent to close blood vessels
   • Bipolar or unipolar cautery to apply heat
   • Laser or heater probe for precise cauterization
   • Staplers or plasma coagulators for sealing blood vessels
6. The scope is slowly withdrawn, and the area is checked for any further issues.

Duration

Typically takes about 15-30 minutes.

Setting

Performed in a hospital, outpatient clinic, or a specialized surgical center.

Personnel

• Gastroenterologist or colorectal surgeon
• Nurses
• Anesthesiologist or sedation nurse, if sedation is used

Risks and Complications

• Common risks: mild discomfort, bleeding, or infection
• Rare risks: perforation of the colon, severe bleeding, or reactions to sedation
• Any complications are managed promptly by the healthcare team.

Benefits

• Immediate visualization and diagnosis of rectal and lower colon issues.
• Effective control of bleeding, reducing the risk of anemia.
• Quick relief if the source of bleeding is found and treated.

Recovery

• Patients may feel slight discomfort or bloating afterward.
• Post-procedure monitoring for a short time if sedation was used.
• Instructions include resting and avoiding strenuous activities for a day.
• Follow-up appointments may be scheduled to monitor recovery.

Alternatives

• Flexible sigmoidoscopy or colonoscopy (more extensive examination)
• Imaging studies like CT colonography
• Conservative management with medications and observation
• Each alternative has different scopes, benefits, and limitations compared to rigid proctosigmoidoscopy.

Patient Experience

• Some discomfort during insertion and examination.
• Sedation helps relax and minimize patient stress.
• Post-procedure bloating or mild pain is controlled with medications and usually subsides quickly.