GI/GU
Colonoscopy and Smear Polypectomy
COLONOSCOPY REPORT AND SMEAR POLYPECTOMY
INDICATION: Transfusion requiring anemia. Need for chronic anticoagulation therapy, in view of mitral valve repair and mechanical valve. Rule out colonic lesion responsible for the chronic blood loss and treat if possible.
PREMEDICATION: Ampicillin 2 gm IV, gentamycin 80 mg IV. Two units of fresh, frozen plasma had been given earlier in the morning in order to correct the INR to acceptable levels. Versed 1 mg IV was given towards the end of the procedure.
PROCEDURE: The Olympus PCF160 AL video colonoscope was introduced into the cecum after overcoming a good deal of difficulty related to elongated, tortuous colonic loops, which appeared to be somewhat fixed against scars from past surgical procedures. Introduction was accomplished in an atraumatic way. Preparation was perfect so that a complete examination could be accomplished after the appendicial orifice was convincingly reached.
During slow withdrawal from the appendicial orifice, and careful search behind haustrations and flexures, a non-bleeding, unirritated 0.8 cm sessile benign polyp was detected in the proximal descending colon and safely removed with the cautery snare. Before that, a clamshell particle was seen located in the appendicial orifice and a larger clamshell particle was seen between haustrations of the ascending colon. There appeared to be no mucosal surface trauma related to the clamshells. Mucosal surfaces, in general, were smooth, glistening, and normal. No evidence of active bleeding from the ileocecal valve or from any point in the colon could be demonstrated. Mild diverticulosis was noted, predominantly in the sigmoid and left colon region. No pathology was seen on retroflex inspection of the internal sphincter region. Overall, the procedure was well tolerated.
IMPRESSION:
1. Benign, proximal descending colon polyp, removed.
2. Mild diverticulosis.
3. No evidence of active or potential bleeding detected during this examination.
SUGGEST: Allow low-residue diet tonight. Avoid sharp-edged, hard food particles. Resume anticoagulant therapy as before. If Hematest-positivity continues, would advise wireless endoscopy with the endoscopy capsule.