| Theme | Urgent colonoscopy for decision of diagnosis and treatment | |
|---|---|---|
| Title | Present status of emergency colonoscopy in our university endoscopy center | |
| Publish Date | 2006/01 | |
| Author | Hiroshi Kashida | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Kazuo Ohtsuka | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Fuyuhiko Yamamura | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Keita Sasajima | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Junichi Ukegawa | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Yoko Matsui | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Tatsuhiko Matsushita | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Yasutoshi Kobayashi | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Ryo Chinzei | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Shin-ei Kudo | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| [ Summary ] | The annual number of colonic examinations in our institute is between 4,000 and 4,500, out of which 200 - 250 are “urgent” examinations. About 30 of these are considered to be real emergency cases, though the definition of emergency endoscopy is not fixed. One of the staff members of our digestive disease center stays in the hospital and at least one colonoscopic specialist is on call every night and every weekend. The major indication for emergency colonoscopy was rectal bleeding. The most frequent cause of rectal bleeding was bleeding after the endoscopic removal of colorectal tumors, followed by bleeding diverticula, ischemic colitis, bacterial enterocolitis, inflammatory bowel disease, hemorrhoids, and vascular abnormalities. Some cases of post-polypectomic bleeding, diverticular bleeding and vascular abnormalities requiring endoscopic hemostasis. Minor indications for emergency colonoscopy may include torsion of the sigmoid colon, ileus caused by a rectal or sigmoid cancer, a foreign body in the rectum, etc. Colonoscopic examination is considered to be contraindicated in cases with gastrointestinal perforations or acute peritonitis. We must be very cautious in cases with ileus, because colonoscopy can cause deterioration of the patient's condition. In case with bleeding, bowel preparation should be done as fully as possible even before emergency colonoscopy ; otherwise not only colonoscopic insertion but also detection of the affected area will be difficult, and the examination will take too much time and produce too much pain for the patient. |
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