45337 Sigmoidoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed

Name of the Procedure:

Sigmoidoscopy, flexible; with decompression (for pathologic distention) (e.g., volvulus, megacolon), including placement of decompression tube.

Summary

A flexible sigmoidoscopy with decompression is a medical procedure used to examine the lower part of the colon and relieve pressure caused by conditions such as volvulus (twisting of the colon) or megacolon (abnormal dilation of the colon). This procedure often involves inserting a decompression tube to alleviate distention.

Purpose

This procedure addresses abnormal distension in the lower colon, which can be caused by pathological conditions such as volvulus or megacolon. The goals are to visually assess the colon, relieve pressure, and improve patient symptoms by decompressing the distended segment.

Indications

• Severe abdominal pain
• Symptoms of bowel obstruction (e.g., vomiting, distension)
• Diagnosed volvulus or megacolon
• Inability to pass gas or stool
• Radiographic evidence of colonic distension

Preparation

• Fasting for at least 6-8 hours before the procedure.
• Bowel preparation with laxatives or enemas to clear the colon.
• Discontinuation of certain medications as advised by the healthcare provider.
• Pre-procedure blood tests and imaging studies may be required.

Procedure Description

1. The patient is positioned on their side.
2. Sedation or anesthesia may be administered to ensure comfort.
3. A flexible tube with a camera (sigmoidoscope) is inserted through the rectum.
4. Air is introduced to expand the colon for better visualization.
5. If pathological distension is found, a decompression tube is inserted through the sigmoidoscope to relieve pressure.
6. The sigmoidoscope and decompression tube are carefully removed after the procedure.

Duration

The procedure typically takes about 15-30 minutes.

Setting

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

Personnel

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

Risks and Complications

• Perforation of the colon
• Bleeding
• Infection
• Adverse reaction to sedation or anesthesia
• Recurrence of distension

Benefits

• Relief from symptoms of colonic distension
• Improved gastrointestinal function
• Prevention of further complications related to volvulus or megacolon

Recovery

• Observation for a short period post-procedure to monitor for complications.
• Instructions on diet and activity level post-procedure.
• Follow-up appointments to assess condition and ensure no recurrence.

Alternatives

• Conservative management with medications and bowel rest
• Surgical intervention in severe cases
• Pros and cons of alternatives generally depend on the severity and underlying cause of the condition.

Patient Experience

• Patients may feel some discomfort and cramping during the procedure.
• There might be mild bloating or gas pain post-procedure.
• Pain management typically involves over-the-counter pain relievers.
• Most patients can resume normal activities within a day.