Case 1: Zhou xx, male, 56 years old. He was admitted to the hospital with the chief complaint of “prolapsed swelling in the anus after stool for 10 years”, and was admitted to the hospital for surgery with the diagnosis of “mixed hemorrhoid”, and was examined after admission, such as routine blood count and immune system, and was found to have no contraindications for hemorrhoid surgery. After antibiotics, herbal sitz bath and corresponding anorectal drug exchange treatment, he was discharged after half a month, but one month after discharge, he had symptoms of stool with pus and blood, so he underwent fiberoptic colonoscopy and found a 50cm colon tumor at the local anal verge. He was admitted to the hospital for surgery and was discharged half a month later.
Hidden reasons and impressions: The patient complained of “prolapsed intra-anal mass after stool for 10 years”, and the specialist examination showed that the hemorrhoid nucleus near the dentate line was obvious and prolapsed out of the anal verge with the withdrawal of the anoscope, the end of the rectum was not palpated on finger diagnosis, the finger sleeve was not stained with blood, and the patient did not have frequent stools, blood (eclipsed blood, pus blood, etc.), weight loss and other corresponding symptoms and manifestations of rectal cancer. The patient had no symptoms and manifestations of rectal cancer, the diagnosis of “mixed hemorrhoid” was clear, there was no contraindication to surgery, and the surgery was performed under local anesthesia with external peeling and internal ligation of mixed hemorrhoid, and the patient was cured after the surgery. The patient had obvious symptoms of hemorrhoids and no obvious symptoms of corresponding rectal cancer, but the tumor was obvious under fiberoptic colonoscopy, so it is necessary to perform fiberoptic colonoscopy for different patients.
Case 2: Bai xx, male, 60 years old. He was admitted to the hospital with the complaint of “bleeding in stool for 1 week” and “lower gastrointestinal bleeding to be investigated”. “After 3 days of treatment, the bleeding symptoms improved significantly and the patient gave up the treatment. The patient was admitted to hospital for surgery and was discharged after healing.
Hidden reasons and impressions: the patient had obvious symptoms of bleeding in stool, no frequent stools, no other obvious symptoms of intestinal tumor such as weight loss, no intestinal tumor was seen in the first examination by fiberoptic colonoscopy, and the bleeding symptoms improved significantly after treatment, so it was necessary to perform colonoscopy again, but because the patient gave up treatment and thought that the condition was good, no examination was needed, and after 1 month, bleeding symptoms appeared again, fiberoptic colonoscopy was performed again to clarify the tumor The tumor was clearly identified and treated surgically.
Case 3: Yang xx, female, 58 years old. She was admitted to the hospital with the complaints of “chronic colitis”, “diabetes mellitus”, “schizophrenia”, and “blood in the stool with pain and discomfort in the lower abdomen for half a month”. “At the time of admission, the diagnosis of local fiberoptic colonoscopy was chronic colitis. The colonoscopy did not reveal intestinal ulcers and tumors. Symptomatic treatment after admission resulted in significant improvement of symptoms. The patient was then discharged from the hospital. After discharge, he underwent fiberoptic colonoscopy again at a provincial hospital and was found to have a colonic tumor, which was found to be malignant and in the middle and late stages of the disease.
Hidden reasons and feelings: when the patient was admitted to the hospital, no intestinal tumor was seen in the local fiberoptic colonoscopy, at the same time, the patient had no obvious symptoms of intestinal cancer, no symptoms such as frequent blood in the stool, pain and discomfort in the lower abdomen, and the symptoms improved after medication; when fiberoptic colonoscopy was performed again, colon tumor was found, and it had reached the middle and late stage, no surgical significance, and conservative treatment.
Significance of e-colonoscopy.
E-colonoscopy has a decisive role in the diagnosis and treatment of ulcer disease, gastrointestinal bleeding, colorectal cancer, colorectal polyps, various enteritis and other diseases.
Electronic colonoscopy is feasible in all of the following cases without contraindications
1, lower gastrointestinal bleeding of unknown cause.
2, chronic diarrhea of unknown origin.
3.Unexplained abdominal masses that cannot exclude lesions of the large intestine and the end of the ileum.
4.Unexplained lower and middle abdominal pain.
5.Suspected benign or malignant colon tumor, which cannot be diagnosed by X-ray examination.
6.Suspected of chronic intestinal inflammatory diseases.
7.Abnormalities are found in barium enema or intestinal system examination, and the nature and scope of lesions need to be further clarified.
8.Determine the scope of lesions before surgery for colon cancer, postoperative review and follow-up of the efficacy of colon cancer and polyps.
9.Low-grade intestinal obstruction of unknown origin.
Features of e-colonoscopy
Electronic colonoscopy is the best choice for diagnosis of rectal and colon lesions, it is through the electronic camera probe installed in the front of the colonoscope to transmit the image of the colon mucosa to the electronic computer processing center, and then displayed on the monitor screen, which can observe the small changes of the large intestinal mucosa. Such as cancer, polyp, ulcer, erosion, bleeding, pigmentation, varicose and dilated blood vessels, congestion, edema, etc. The images are clear and realistic.
The e-colonoscope can also feed biopsy forceps through the instrument channel of the colonoscope to obtain rice-sized tissues for pathological sectioning and testing or other special staining, which can further classify the nature of mucosal lesions histologically, such as the degree of inflammation and differentiation of cancer, and help to understand the severity of lesions and guide the formulation of correct treatment plan or judge the treatment effect. Endoscopic treatment of some diseases or lesions of the colon, such as polyps, bleeding, foreign bodies, etc., can also be performed through the colonoscopy instrument channel.