Proctosigmoidoscopy, rigid; with decompression of volvulus
CPT4 code
Name of the Procedure:
Proctosigmoidoscopy, rigid; with decompression of volvulus
Common Name(s): Rigid Sigmoidoscopy with Volvulus Decompression
Summary
A proctosigmoidoscopy, rigid, with decompression of volvulus is a medical procedure used to examine the rectum and a portion of the colon using a rigid, tube-like instrument. It specifically aims to relieve twisting in the bowel, known as a volvulus, which can cause a blockage.
Purpose
This procedure addresses conditions such as a volvulus, where a part of the colon twists and causes an obstruction. The main goals are to diagnose the extent of the twisting and to alleviate the obstruction to restore normal bowel function.
Indications
- Symptoms such as severe abdominal pain, distention, bloating, and constipation suggestive of a bowel obstruction.
- Imaging studies showing the presence of a sigmoid volvulus.
- Failure to resolve volvulus through non-invasive measures.
Preparation
- Fasting for a specified period before the procedure (usually 8-12 hours).
- Bowel cleansing regimen, such as laxatives or enemas, to ensure a clear view during the procedure.
- Pre-procedural assessments, including blood tests and imaging studies like X-rays or CT scans.
Procedure Description
- The patient is placed in a specific position, typically on their side.
- Sedation or local anesthesia is administered to minimize discomfort.
- A rigid sigmoidoscope is gently inserted into the rectum and guided through the sigmoid colon.
- If a volvulus is detected, the physician will attempt to untwist the bowel using the scope.
- Air may be introduced to the colon to help decompress the twisted segment.
- The instrument is slowly withdrawn after successful decompression and examination.
Duration
The procedure typically takes between 30 to 60 minutes, depending on the complexity.
Setting
This procedure is usually performed in a hospital’s endoscopy suite, outpatient clinic, or a specialized surgical center.
Personnel
- Gastroenterologist or colorectal surgeon
- Endoscopy nurse
- Anesthesiologist or nurse anesthetist (if sedation is used)
Risks and Complications
- Common risks: Abdominal discomfort, bloating, and minor bleeding.
- Rare risks: Perforation of the colon, infection, and adverse reactions to anesthesia.
- Management of complications: Immediate surgical intervention for perforation and antibiotics for infections.
Benefits
- Immediate relief of bowel obstruction symptoms.
- Prevention of more severe complications such as bowel necrosis or perforation.
- Diagnostic benefits to inform further treatment.
Recovery
- Patients are monitored for a few hours post-procedure for adverse effects.
- Instructions on dietary adjustments and activity restrictions will be provided.
- Most patients recover quickly but may need a short-term follow-up to ensure normal bowel function.
- Return to normal activities is often allowed within a few days, depending on individual recovery.
Alternatives
- Non-invasive measures like enemas or endoscopic decompression.
- Surgical intervention for more severe cases or if non-invasive methods fail.
- Pros and cons: Non-invasive measures are less risky but may not be effective; surgery is more definitive but carries higher risks and longer recovery.
Patient Experience
During the procedure, patients might feel pressure, bloating, or mild discomfort despite sedation or anesthesia. Post-procedure, patients could experience mild abdominal cramping and gas. Pain management options include over-the-counter pain relievers and prescribed medications for more severe discomfort.