Rektoromanoskopiya
Rektoromanoskopiya – endoscopic inspection at which rectum – a rectum, sigma romanum – a sigmoid gut looks round mucous a straight line and distal department of a sigmoid gut (Latin). The research is conducted by means of the special device – a rektoromanoskop who represents a tube (length of 25-35 cm and with a diameter of 2 cm) with lenses, the lighter and the device for air forcing.
Rektoromanoskopiya in Russia began to carry out in the 19th century (S. P. Fedorov and his pupils). Now this manipulation is widely used in medicine for detection of diseases of intestines.
Rektoromanoskopiya allows to examine a mucous membrane of intestines throughout 15-30 cm from an anus and to reveal various pathologies, also at this procedure capture of a biopsy is possible (the site of fabric for a histologic research under a microscope). This research also is a preparatory stage before other researches of intestines (an irrigoskopiya, a kolonoskopiya).
Indications to a rektoromanoskopiya
- Suspicion of oncological pathology of a direct or sigmoid gut;
- Intestinal bleedings, mucifying or pus from a rectum;
- Disturbances of a chair (long locks, ponosa, or change of character of a chair);
- Chronic inflammatory diseases of a rectum (for example, chronic paraproctitis);
- Chronic hemorrhoids (for assessment of a condition of internal hemorrhoidal nodes);
- Men at suspicion of a prostate tumor, at women – at suspicion of a tumor have areas of a small pelvis;
- As a preparatory stage before further inspection of intestines (an irrigoskopiya, a kolonoskopiya);
Rektoromanoskopiya of intestines can the medical procedure, for example, at a polyp of a rectum of the small sizes be possible to remove education in the endoscopic way.
Contraindications
As contraindications to this manipulation serves serious condition of the patient (for example, the expressed cardiovascular pathology, heavy degree of respiratory insufficiency, disturbance of cerebral circulation) when the risk of carrying out a rektoromanoskopiya exceeds its expediency.
As relative contraindications to carrying out inspection serve acute inflammatory diseases in the field of an anus (an acute paraproctitis, acute hemorrhoids with thrombosis of nodes, a proctal crack).
In case of emergency (for example, plentiful intestinal bleeding with a loss of consciousness) the rektoromanoskopiya of intestines can be executed practically to any patient according to vital indications.
Technology of carrying out rektoromanoskopiya
This manipulation is made in specially equipped office. Usually the rektoromanoskopiya is carried out without anesthesia (the procedure is almost painless). In certain cases perhaps local anesthesia (for example if the patient has a proctal crack or traumatic damage to area of an anus). Anesthesia intravenous is used in rare instances at the patient's insistance.
Before a rektoromanoskopiya surely at first conduct a manual research of a rectum. When carrying out manipulation position of the patient can be genucubital (the patient costs on "all fours", leaning on knees and area of elbows) or lying on the left side.
The tube of a rektoskop is entered on 4-5 cm after plentiful greasing of area of an anus by a liquid paraffin. Then manipulation is carried out under control of an eye, in a tube of the device air for a raspravleniye of folds of mucous is pumped up. The patient needs to explain that in process of advance of a rektoskop he can have desires on defecation, this normal phenomenon. At the height of 12-14 cm usually there is an intestines bend (transition of a rectum to sigmoid) therefore at this moment the maximum relaxation of the patient for further passing of a rektoskop is required. As during a rektoskopiya of intestines air is forced, the patient can have a discomfort and painful feelings in the lower part of a stomach. If the research is extremely painful for the patient, then it is stopped.
Blood, slime and liquid fecal masses which interfere with carrying out detailed survey of mucous delete with a suction machine. When carrying out a rektoromanoskopiya it is possible to take material for a histologic or cytologic research (by means of kelectomes, a special brush, a cotton plug). Histologic research in case of identification of education gives the answer about its high quality. In case of holding a procedure with the medical purpose removal of a polyp by means of a coagulative loop is possible.
Complications
In extremely exceptional cases at a rektoromanoskopiya of intestines bleeding (for example, after a biopsy or removal of a polyp) and perforation of a gut is possible (formations of defect in a gut wall). In case of perforation an urgent operative measure is required.
Preparation for a rektoromanoskopiya
Mucous from within special preparation (cleaning of intestines) before carrying out a research in details is required to examine.
The technique of preparation includes dietary restrictions – within 24-48 hours before the procedure to exclude fruit, vegetables and rough food from a diet. Some medical institutions carry out a rektoromanoskopiya only on an empty stomach. Cleaning of intestines is carried out by various ways and depends on preferences of the doctor.
There are following methods of preparation for a rektoromanoskopiya:
- Cleansing enemas (at first they are carried out on the eve of the research in the evening, and in day of a research in the morning – a minimum in 3 hours prior to the procedure);
- By means of the laxative drugs accepted through a mouth (for example, дюфалак, фортранс, форлакс, flit);
- By means of special microclysters with laxative effect (Микролакс). It is possible to use this drug just before a research that reduces preparation time (2-3 microclysters in 30-40 minutes prior to inspection).
Preparation for a rektoromanoskopiya has to be careful as the research will be not informative at insufficient extent of cleaning of intestines. The combination of cleansing enemas and laxative drugs is possible, especially it is urgent at patients with locks.
Rektoromanoskopiya at children
Rektoromanoskopiya at children of younger age is carried out only in the conditions of the general anesthesia (intravenous). For performance of a research use special children's rektoskopa of the smaller size.
Preparation for a rektoromanoskopiya at children does not differ from training of adults (laxative and cleansing enemas can be used).
Indications to carrying out a rektoromanoskopiya at children are intestinal bleedings, loss of tumorous educations, hemorrhoidal nodes or a wall of a gut (a prolapse mucous). By means of this research it is possible to reveal anomalies of development of distal department of a large intestine, to distinguish nonspecific ulcer colitis, a proctosigmoiditis and other pathology.
As contraindications to a rektoromanoskopiya at children serve peritonitis, inflammatory changes in area of an anus, narrowing of an anus.
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