Passing the Anal Sphincter

After completing inspection and palpation and, if necessary, administering an analgesic, the actual endoscopic examination can begin. A local anaesthetic lubricating jelly, such as a lubricant containing Lidocain, should be applied liberally. The endoscope tip is then inserted in the rectum and guided digitally without visualization. The examiner should explain to the patient the steps being taken and inform the patient that he may experience the urge to evacuate his bowels. The endoscope tip is inserted in the direction indicated by preceding palpation; as a rough guide, the direction of the anal canal runs in a line between the anus and the navel. After "blindly" inserting the endoscope 4-5 cm,

Retroflexion Colonoscopy

Figure 5.1 Examining the perianal region in the left lateral position: patient with Crohn disease; reddened fistula opening at about the 6-o'clock position.

Perianal Skin Tags Form

Fig. 5.2 Inspecting the perianal region.

a Total rectal prolapse. b Pronounced circular anal skin tags.

Fig. 5.2 Inspecting the perianal region.

a Total rectal prolapse. b Pronounced circular anal skin tags.

Anal Skin Tags Hypertrophied Anal Papilla

Fig. 5.3 Endoluminally palpable obstructions.

a Soft, stalklike obstructions with smooth surface in the anal canal (hypertrophied anal papilla on the dentate line, endoscope inverted in rectum). b Sessile, submucosal obstruction with indentation in the center, 6 cm above the anus (histology: lymphoma). c Large, endoluminal obstruction 5 cm above the anus (luminal obstruction due to polyp; histological adenoma with severe intraepithelial neoplasia). d Hardened semicircular obstruction in distal rectum (broadbased growing carcinoma with spontaneous bleeding).

Inverted Sphincter

Fig. S.5 Centering the rectal lumen before continuing colonoscopy.

Fig. 5.6 Colostomy (appositional streaks of blood due to acute lower gastrointestinal bleeding).

Fig. 5.4 After "blindly" advancing the endoscope in the rectum, the instrument is withdrawn. Direct view of the rectal wall. After withdrawal and air insufflation the lumen can be seen (lower right).

Fig. S.5 Centering the rectal lumen before continuing colonoscopy.

Fig. 5.6 Colostomy (appositional streaks of blood due to acute lower gastrointestinal bleeding).

b a d c air is insufflated and the endoscope tip is pulled back until the lumen of the distal rectum can be seen (Fig. 5.4). The rectal lumen is then centered in the middle of the monitor screen (Fig. 5.5) and the endoscope is advanced under visualization of the lumen to the rectosigmoid junction.

At this point in the examination there has not yet been sufficient inspection of the distal rectum or anal canal, which will be more closely examined on withdrawal of the endoscope later (possibly also using retroflexion of the endoscope in the rectum; see below).

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Responses

  • phillipp baum
    Can anal skin tags be circular?
    6 years ago
  • asphodel
    Is it always necessary to remove a hypertrophied papilla on the rectum?
    4 years ago
  • temesgen
    How to get rid of anus skin tags?
    1 year ago
  • dieter
    Can anal tags be pushed back in?
    6 months ago

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