Name of the Procedure:

Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery.

Common name(s): Rigid Proctosigmoidoscopy with Lesion Removal

Summary

A proctosigmoidoscopy is a medical procedure in which a healthcare provider inspects the rectum and the lower part of the colon (sigmoid colon) using a rigid viewing instrument called a proctoscope. In this particular procedure, any tumor, polyp, or lesion found is removed using hot biopsy forceps or bipolar cautery.

Purpose

This procedure addresses the detection and removal of abnormal growths such as tumors, polyps, or other lesions in the rectum and lower colon. The goal is to eliminate these anomalies to prevent conditions like colorectal cancer or to treat symptomatic issues.

Indications

• Presence of symptoms like rectal bleeding, persistent pain, or changes in bowel habits
• Positive screening results for colorectal cancer
• Identified polyps or lesions found in previous examinations

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• A bowel cleanse or enema may be required to clear the lower colon.
• Medication adjustments might be necessary, particularly for blood thinners.
• Diagnostic tests like blood work or imaging studies might be conducted prior.

Procedure Description

1. The patient will lie on their side with knees drawn to the chest.
2. Sedation or local anesthesia may be administered to minimize discomfort.
3. The proctoscope, a rigid tube, is gently inserted into the rectum to visualize the area.
4. Hot biopsy forceps or a bipolar cautery tool is used to remove any identified tumor, polyp, or lesion.
5. The removed tissue is often sent to a laboratory for further analysis.
6. The proctoscope is carefully withdrawn after the procedure.

Duration

Typically, the procedure takes about 30 to 60 minutes.

Setting

This procedure is usually performed in an outpatient clinic, hospital, or surgical center.

Personnel

• Gastroenterologist or colorectal surgeon
• Nursing staff
• Anesthesiologist, if sedation is used

Risks and Complications

• Common risks: minor bleeding, discomfort, and temporary bloating.
• Rare complications: perforation of the bowel, significant bleeding, infection.

Benefits

• Early detection and removal of potentially cancerous polyps or tumors.
• Relief from symptoms associated with colonic lesions.
• Prevents progression of precancerous growths.

Recovery

• Patients may experience mild discomfort or bloating post-procedure.
• Rest is recommended for the remainder of the day.
• Normal activities can usually be resumed within 24 hours.
• Follow-up appointments may be necessary to monitor recovery and biopsy results.

Alternatives

• Flexible sigmoidoscopy or colonoscopy.
• Non-invasive imaging tests (e.g., CT colonography).
• Medication or watchful waiting, depending on the lesion's characteristics.
• Each alternative has distinct pros and cons in terms of invasiveness, accuracy, and recovery time.

Patient Experience

During the procedure, the patient may feel some pressure or discomfort. Sedation can help manage pain and anxiety. Post-procedure, mild cramping and bloating are common. Pain management options, such as over-the-counter analgesics, may be provided to enhance comfort during recovery.