Name of the Procedure:

Colonoscopy through stoma with decompression (for pathologic distention) - also known as Decompressive Colonoscopy

Summary

A colonoscopy through a stoma is a medical procedure where a flexible tube with a camera (colonoscope) is inserted through a surgically created opening (stoma) to examine the colon. This procedure is specifically used to relieve pathological distention conditions such as volvulus or megacolon by decompressing the built-up gas and liquids. When needed, a decompression tube is placed during the procedure to maintain relief of the distention.

Purpose

This procedure is aimed at treating conditions that cause pathological distention of the colon. It helps to relieve symptoms such as abdominal pain, bloating, and discomfort associated with these conditions. By decompressing the colon, it also helps prevent further complications such as tissue death or perforation.

Indications

• Volvulus: twisting of a part of the colon causing obstruction.
• Megacolon: an abnormally enlarged colon due to chronic distention.
• Severe abdominal pain or bloating due to gas accumulation.
• Inability to pass stool or gas.

Preparation

• Fasting: Patients may need to fast for several hours before the procedure.
• Medication Adjustments: Certain medications might need to be adjusted or stopped prior to the procedure.
• Diagnostic Tests: A CT scan or abdominal X-rays may be performed to assess the extent of distention and to identify the exact location of the issue.

Procedure Description

1. Sedation/Anesthesia: The patient is generally given sedation for comfort.
2. Insertion: The colonoscope is gently inserted through the stoma.
3. Examination: The colon is inspected to identify the cause and location of distention.
4. Decompression: The gas and liquid causing the distention are aspirated through the colonoscope.
5. Tube Placement: If required, a decompression tube is inserted to maintain decompression and prevent recurrence.
6. Monitoring: The patient is closely monitored for any immediate complications post-procedure.

Duration

The procedure typically takes between 30 minutes to 1 hour, depending on the complexity.

Setting

This procedure is usually performed in a hospital or an outpatient surgical center with appropriate endoscopic facilities.

Personnel

• Gastroenterologists or Colorectal Surgeons: Perform the procedure.
• Nurses: Assist with the procedure and provide patient care.
• Anesthesiologists: Administer sedation or anesthesia and monitor the patient.

Risks and Complications

• Common risks: Bleeding, infection, discomfort at the stoma site.
• Rare complications: Perforation of the colon, adverse reactions to sedation, persistent or worsening of symptoms.

Benefits

• Rapid relief from symptoms of distention.
• Prevention of severe complications like tissue death or perforation of the colon.
• Potentially avoids the need for emergency surgery.

Recovery

• Post-Procedure Care: Monitoring in a recovery area until sedation wears off.
• Instructions: Patients are advised on activities, diet, and signs of potential complications to watch for.
• Recovery Time: Most patients can resume normal activities within a day or two but may need to follow specific dietary restrictions.
• Follow-Up: Scheduled appointment to check the effectiveness of decompression and tube placement.

Alternatives

• Non-invasive treatments: Medications for bowel regulation.
• Surgical Options: In severe cases, surgery to correct volvulus or remove diseased segments of the colon.
• Pros and Cons: Non-invasive methods may not be effective for immediate relief, while surgery carries more risks but can offer a permanent solution.

Patient Experience

• During the procedure: Patients will generally be sedated and should not feel pain, though they may experience mild discomfort.
• After the procedure: Some soreness and bloating are expected; pain is usually managed with medication.
• Comfort: Sedation helps to ensure patient comfort during the procedure, and nausea or discomfort post-procedure is typically brief.