COLONOSCOPIC EVALUATION OF LOWER OF PATHOLOGIES

Dr. Rakesh Faujdar, Dr. Ashok Kumar, Dr. Kirti Katiyar

Abstract


Background: To evaluate Endoscopy/Colonoscopy as a diagnostic modality in patients presenting with symptoms of Lower Gastrointestinal Tract Pathology.

Material and method: We studied 76 patients who were admitted in the OPD or emergency of M.L.B. Medical College, Jhansi and presented with the symptoms suggestive of lower Gastrointestinal pathology and colonoscopy was performed in the Department of Surgery between a period of one year from Nov 2012 to Oct 2013.

Result and Discussion: The colonscopy was performed in most of our cases (93.42%) with tramodol (I/V) only after psychologically preparing the patients in rest of the patients (6.58%) diazepam (I/V) was given along with Tramadol(I/V). we were able to intubate the caecum (19.74%) in hepatic flexure in 47.37%,in the remaining cases we intubated splenic flexure in 18.42% and sigmoid colon in 14.48%, which were the areas containing the pathology and either we intentionally did not go beyond that or scope was not negotiable beyond that. In developing countries where infective diarrhea is still common, selecting patients for colonoscopy is more difficult. In this study, Of all the pathologies included non specific inflammation (23.69%) was the most common pathology encountered as in previous study(34.61%) followed by malignancy (14.46%), ulcerative colitis (10.52%), polyp (07.90%), solitary ulcer (5.26%),chrohn’s disease(03.95%) and normal study in remaining (34.21%) cases, Where as in previous study after nonspecific inflammation Ulcerative colitis(13.46%) was the most common pathology followed by malignancy(9.61%) and solitary ulcer(3.84%), diverticular disease is not found in any of the cases. Out of 76 patients biopsy was taken in 34 (44.74%) patients. Abdominal distention and pain (07.89%) was the most common complication after colonoscopy which releaved spontaneously within one hour or two after passing flatus.one patient developed severe distention and required admission for 24 hours with nasogastric decompression. Bleeding (03.95%) following Minor traumatic injury to bowel mucosa that occurred during the procedure is next common complication which was managed with conservative treatment. Bacteraemia as evidenced by fever occurred in one (1.31%) patient who was managed with antibiotics. Out of 76 patients malignancy was found in 11patients all of which were adenocarcinoma. They constituted 14.46%, out of these 11 patients, 4 had carcinoma at rectosigmoid junction,2 in rectum and 3 in descending colon and 2 in ascending colon. Guillen and fordy study showed an incidence of carcinoma of 12%. So our study showed slightly more incidence of carcinoma.

Conclusion: Colonoscopy is also the best modality for diagnosing malignancy of large bowel and for surveillance in high risk patients and also in those patients who have undergone previous colorectal surgery for malignancy and long standing inflammatory bowel disease



Keywords


Colonoscopy, Solitary rectal ulcer, Diverticular diseases

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