45393 Colonoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed

Name of the Procedure:

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

Summary

A colonoscopy with decompression is a medical procedure used to examine the inside of the colon using a flexible tube with a camera, and simultaneously relieve pathologic distention by placing a decompression tube.

Purpose

This procedure addresses conditions like volvulus or megacolon, which cause abnormal distention of the colon. The goal is to decompress the distended colon, prevent further complications, and diagnose any underlying issues.

Indications

• Severe abdominal pain and bloating
• Symptoms suggesting bowel obstruction
• Diagnosed volvulus or megacolon
• Abnormal imaging results indicating colon distention

Preparation

• The patient must follow a clear liquid diet for 24 hours before the procedure.
• Bowel cleansing with a prescribed laxative solution.
• Adjustments in medications (e.g., stopping anticoagulants).

Procedure Description

1. The patient is sedated or given anesthesia.
2. A flexible colonoscope is inserted through the rectum to examine the colon.
3. If pathologic distention is detected, a decompression tube is placed to relieve pressure.
4. The colonoscope is carefully maneuvered to examine internal structures and take samples if necessary.
5. Upon completion, the instruments are removed.

Duration

Typically, the procedure takes about 30 to 60 minutes.

Setting

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

Personnel

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

Risks and Complications

• Bleeding
• Perforation of the colon
• Infection
• Adverse reaction to sedation
• Incomplete relief of distention

Benefits

• Immediate relief from symptoms of distention
• Early diagnosis of underlying conditions
• Potential prevention of severe complications like bowel perforation

Recovery

• Post-procedure observation until sedation wears off
• Clear liquids and gradual reintroduction of solid foods
• Avoiding heavy lifting or strenuous activities for a few days
• Follow-up appointments as needed

Alternatives

• Use of imaging techniques like X-rays or CT scans for diagnosis
• Non-invasive decompression methods (e.g., nasogastric tube)
• Surgical intervention if the procedure is not successful or not possible

Patient Experience

• The patient may feel bloated or crampy post-procedure.
• Sedation minimizes discomfort during the procedure.
• Pain management includes over-the-counter pain relief and prescribed medications if needed.
• Most patients can resume normal activities within a few days, with specific recovery steps provided by the healthcare team.