ABSTRACT
<p>A 74-year-old man with diabetes underwent colonoscopy as routine screening for coloncancer. An <i>Anisakis</i> larva was found incidentally during colonoscopy usingthe retroflexion technique in the ascending colon, and was removed using a forceps.Asymptomatic colonic anisakiasis is very rare, and few reports have described diagnosisand treatment of anisakiasis during colonoscopy by the retroflexion technique in theascending colon. We have reported this rare case along with a literature review.</p>
ABSTRACT
BACKGROUND/AIMS: Colonoscopy is less effective at screening for colorectal cancer in the right side of the colon. Retroflexion during colonoscopy is expected to improve the detection rate of colorectal adenomas. The aim of the present study was to evaluate the usefulness of retroflexion in the right-sided colon. METHODS: From April to November 2013, a total of 398 patients were enrolled in this study. For each patient, a cap-assisted colonoscopic examination was performed. After cecal intubation, a forward view examination from the cecum up to the hepatic flexure was performed and all identified polyps were removed. The colonoscope was reinserted to the cecum, and a careful second forward view examination of the cecum to the hepatic flexure was performed, with removal of additionally identified polyps. The colonoscope was then reinserted to the cecum and retroflexed; a third colonoscopic examination was then performed to the hepatic flexure in retroflexion with removal of additional polyps. Total polyp numbers and characteristics were compared between the two forward view examinations and the retroflexion examination. RESULTS: A successful retroflexion was performed in 90.2% of patients. A total of 213 polyps and 143 adenomas were detected in the right-sided colon using the routine method of examining the right colon twice in forward view. An additional 35 polyps and 24 adenomas were detected on retroflexion. Of these 35 polyps, 27 (77.1%) were small-sized polyps (< or =5 mm) and 24 (71.4%) were adenomas. Finding additional adenomas using the retroflexion technique was associated with older age. CONCLUSIONS: Colonoscopic retroflexion is helpful in the detection of cecum and ascending colon adenomas, especially small-sized adenomas (< or =5 mm). It is particularly useful in older patients.
Subject(s)
Humans , Adenoma , Cecum , Colon , Colon, Ascending , Colonoscopes , Colonoscopy , Colorectal Neoplasms , Intubation , Mass Screening , PolypsABSTRACT
BACKGROUND/AIMS: There have been several studies showing that retroflexion (RF) in the right colon (RC) could reduce the polyp miss rate of proximal colon during colonoscopy. This study was conducted to evaluate the additional benefit of RF technique in the RC. METHODS: Patients who underwent colonoscopy from May 2008 to April 2011 were enrolled in the study. Data were obtained by retrospectively reviewing the medical records. RF was attempted in every patients undergoing colonoscopy since May 2008 except in cases of small RC vault, co-morbidity, severe diverticulosis, failed RF despite two trials, complaints of severe abdominal pain, or time burden. At first, RC was examined under direct vision. It was then examined by RF to detect missed polyps during the initial observation. Finally, the RC was re-examined with direct view. RESULTS: The cumulative RF success rate in the RC was 78.84% (1,805 of 2,319). The RF success rate increased with the number of cases (50% at 160 cases, 70% at 400 cases, and reached near 90% over 1,000 cases). Few polyps (4.88%) were detected only with RF and the additional adenoma detection rate was 3.32%. The additional polyp/adenoma detection rates were higher in the old age group (p<0.01). There were no RF associated perforation or severe complication. CONCLUSIONS: Using RF examination, additional 4.88% of polyps could be detected in the RC. This technique could be a useful and safe method to detect hidden polyp during colonoscopy.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Adenoma/diagnosis , Colon, Descending/pathology , Colonic Neoplasms/diagnosis , Colonic Polyps/diagnosis , Colonoscopy , Retrospective StudiesABSTRACT
BACKGROUND/AIMS: No clear data have been established and validated regarding whether rectal retroflexion has an important and therapeutic impact. The aim of the present study was to evaluate the diagnostic yield and therapeutic impact of rectal retroflexion compared with straight view examination. METHODS: A prospective single-blind study was conducted. Consecutive patients evaluated between October 2011 and April 2012 were included. RESULTS: A total of 934 patients (542 women, 58%) were included. The mean age was 57.4+/-14.8 years. Retroflexion was successful in 917 patients (98.2%). Distinct lesions in the anorectal area were detected in 32 patients (3.4%), of which 10 (1%) were identified only on retroflex view and 22 (2.4%) on both straight and retroflex views. Of the 32 identified lesions, 16 (50%) were polyps, nine (28.1%) were angiodysplasias, six (18.8%) were ulcers, and one (3.1%) was a flat lesion. All 10 patients (1%) in whom lesions were detected only by rectal retroflexion showed a therapeutic impact. CONCLUSIONS: Rectal retroflexion has minimal diagnostic yield and therapeutic impact. However, its low rate of major complications and the possibility of detecting lesions undetectable by straight viewing justify its use.
Subject(s)
Female , Humans , Angiodysplasia , Colonoscopy , Polyps , Prospective Studies , Rectum , Single-Blind Method , UlcerABSTRACT
O presente relato descreve o caso de uma fêmea canina, adulta, sem raça definida, que havia parido há 45 dias e, posteriormente, apresentou ruptura uterina e vaginal com retroflexão e evisceração de bexiga, condição raramente observada em cadelas. O reposicionamento da vesícula urinária e a ovariosalpingohisterectomia (OSH) foram realizados por meio de abordagem cirúrgica, entretanto, o animal veio a óbito durante o segundo procedimento citado. Nesse caso acredita-se que as lesões no trato reprodutor provavelmente ocorreram durante o parto, sendo o óbito atribuído ao quadro de choque séptico.
The current study describes a case of a female dog, adult, mixed breed, 45 days after delivery, which later showing uterine and vaginal rupture with bladder retroflexion and evisceration, condition that is rarely observed in dogs. The replacement of the bladder and ovariosalpingohisterectomy (OSH) were performed by surgical approach, however the animal died during the second procedure. In this case, we believe that the damage in the reproductive tract probably occurred during labor and the death was attributed to septic shock.