Rigid Sigmoidoscopy
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Rigid sigmoidoscopy is usually performed in an outpatient or theater setting in conjunction with a digital rectal examination (DRE) to help facilitate the diagnosis and the management of rectal and anal pathology.
Rigid sigmoidoscopy may produce lesser diagnostic yield than flexible sigmoidoscopy does. In one study, 33.9% of the examinations declared normal by rigid sigmoidoscopy were found to include significant lesions when the examination was performed with flexible sigmoidoscopy. [1]
Indications for rigid sigmoidoscopy include the following:
Contraindications for rigid sigmoidoscopy can be divided into absolute and relative. Relative contraindications can be further divided into surgical and medical groups.
Absolute contraindications include the following:
Relative surgical contraindications include the following:
Relative medical contraindications include the following:
Rigid sigmoidoscopy may also be contraindicated in patients who are highly uncooperative, agitated, or particularly anxious. [5, 8]
In some cases, sigmoidoscopy after colonic surgery may be necessary for evaluation of bleeding or obstruction. This procedure appears to be relatively safe in stable patients; however, it is best deferred until at least 1 week after the operation and reserved for clinically important indications. [7, 9, 10]
The rectum lies in the sacrococcygeal hollow and changes to the anal canal at the puborectal sling formed by the innermost fibers of the levator ani. The rectum has a dilated middle part called the ampulla. The rectum is related anteriorly to the urinary bladder, prostate, seminal vesicles, and urethra in males and to the uterus, cervix, and vagina in females. Anterior to the rectum is the rectovesical pouch in males and the rectouterine pouch in females.
The anal canal is related to the perineal body in front and the anococcygeal body behind; both of these are fibromuscular structures.
For more information about the relevant anatomy, see Large Intestine Anatomy, Colon Anatomy, and Anal Canal Anatomy.
High-risk patients such as those with valvuloplasties need appropriate antibiotic prophylaxis. [5, 11] Sigmoidoscopy is safe in patients with even advanced HIV infection. [9]
If sigmoidoscopy following colonic surgery is judged necessary for evaluation of bleeding or obstruction, it should be postponed until at least 1 week after the operation. [7]
Rao VS, Ahmad N, Al-Mukhtar A, Stojkovic S, Moore PJ, Ahmad SM. Comparison of rigid vs flexible sigmoidoscopy in detection of significant anorectal lesions. Colorectal Dis. 2005 Jan. 7 (1):61-4. [Medline].
Chon HK, Shin IS, Kim SW, Lee ST. High grade anorectal stricture complicating Crohn’s disease: endoscopic treatment using insulated-tip knife. Intest Res. 2016 Jul. 14 (3):285-8. [Medline]. [Full Text].
Recio-Boiles A, Babiker HM. Cancer, Rectal (Rectum). Treasure Island, FL: StatPearls; 2018. [Full Text].
Atamanalp SS, Atamanalp RS. The role of sigmoidoscopy in thediagnosis and treatment of sigmoid volvulus. Pak J Med Sci. 2016 Jan-Feb. 32 (1):244-8. [Medline]. [Full Text].
Isaacs KL. Anoscopy and rigid sigmoidoscopy. Drossman DA, Shaheen NJ, Grimm IS, eds. Handbook of Gastroenterologic Procedures. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. 64-71.
Hardcastle JD. Proctoscopy and sigmoidoscopy. Fielding LP, Goldberg SM, eds. Rob & Smith’s Operative Surgery. 5th ed. London: Butterworths; 1983. 124-6.
Cappell MS, Friedel D. The role of sigmoidoscopy and colonoscopy in the diagnosis and management of lower gastrointestinal disorders: technique, indications, and contraindications. Med Clin North Am. 2002 Nov. 86 (6):1217-52. [Medline].
Iseli A. Sigmoidoscopy. Is it a general practice procedure?. Aust Fam Physician. 1999 Jan. 28 (1):61-4. [Medline].
Cappell MS. Gastrointestinal endoscopy in high-risk patients. Dig Dis. 1996 Jul-Aug. 14 (4):228-44. [Medline].
Cappell MS, Ghandi D, Huh C. A study of the safety and clinical efficacy of flexible sigmoidoscopy and colonoscopy after recent colonic surgery in 52 patients. Am J Gastroenterol. 1995 Jul. 90 (7):1130-4. [Medline].
Dias T, Broeiro P. [Proceedings could be dangerous! An endocarditis clinical case]. Acta Med Port. 2007 Jan-Feb. 20 (1):87-92. [Medline].
Sherwinter DA. A novel adaptor converts a laparoscope into a high-definition rigid sigmoidoscope. Surg Innov. 2013 Aug. 20 (4):411-3. [Medline].
Beamish AJ, Foster JJ, Appleton B. A temporary solution to light source failure in proctoscopy/rigid sigmoidoscopy. Ann R Coll Surg Engl. 2011 May. 93 (4):327. [Medline]. [Full Text].
Wong JCT, Sung JJY. Colonoscopy: preparation, instrumentation, and technique. Wallace MB, Fockens P, Sung JJY, eds. Gastroenterological Endoscopy. 3rd ed. New York: Thieme; 2018. Chap 15.
Mann CV, Gallagher P, Frecker PB. Rigid sigmoidoscopy: an evaluation of three parameters regarding diagnostic accuracy. Br J Surg. 1988 May. 75 (5):425-7. [Medline].
Skittrall JP, Eid-Arimoku L, Joshi M, Newport MJ, Moore EM. Rigid sigmoidoscopy: no contamination of the sigmoidoscopist’s face with faecal flora in a small study. J Hosp Infect. 2016 May. 93 (1):112-3. [Medline].
Takahashi T, Zarate X, Velasco L, Mass W, Garcia-Osogobio S, Jimenez R, et al. Rigid rectosigmoidoscopy: still a well-tolerated diagnostic tool. Rev Invest Clin. 2003 Nov-Dec. 55 (6):616-20. [Medline].
Winawer SJ, Miller C, Lightdale C, Herbert E, Ephram RC, Gordon L, et al. Patient response to sigmoidoscopy. A randomized, controlled trial of rigid and flexible sigmoidoscopy. Cancer. 1987 Oct 15. 60 (8):1905-8. [Medline].
Robinson RJ, Stone M, Mayberry JF. Sigmoidoscopy and rectal biopsy: a survey of current UK practice. Eur J Gastroenterol Hepatol. 1996 Feb. 8 (2):149-51. [Medline].
Corman ML. Colon and Rectal Surgery. Philadelphia: Lippincott Williams & Wilkins; 2005.
Iman Bayat, MBBS, MRCS, FRACS Consultant Vascular and Endovascular Surgeon, Northern Health, Austin Health; Head of Unit, Vascular Surgery at Northern Health, Australia
Iman Bayat, MBBS, MRCS, FRACS is a member of the following medical societies: Royal Australasian College of Surgeons, Royal College of Surgeons of England
Disclosure: Nothing to disclose.
Peter W Gourlas, MD Consulting Staff, Colorectal Unit, Princess Alexandre Hospital, Mater Adults Hospital and Greenslopes Private Hospital
Peter W Gourlas, MD is a member of the following medical societies: Royal Australasian College of Surgeons
Disclosure: Nothing to disclose.
Jodi Hirst, MBBS Specialist Registrar in General Surgery, Mater Misericordiae Adult Hospital
Disclosure: Nothing to disclose.
Brian J Miller, MBBS, LRCP, MRCS, FRCSC, FRACS Associate Professor in General Surgery and Colorectal Surgery, Department of Surgery, University of Queensland, Princess Alexandra Hospital
Brian J Miller, MBBS, LRCP, MRCS, FRCSC, FRACS is a member of the following medical societies: Colorectal Surgical Society of Australia and New Zealand, Gastroenterological Society of Australia, Royal Australasian College of Surgeons, Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.
Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Nothing to disclose.
Vikram Kate, MBBS, MS, PhD, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS Professor of General and Gastrointestinal Surgery and Senior Consultant Surgeon, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), India
Vikram Kate, MBBS, MS, PhD, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS is a member of the following medical societies: American College of Gastroenterology, American College of Surgeons, American Society of Colon and Rectal Surgeons, Royal College of Physicians and Surgeons of Glasgow, Royal College of Surgeons of Edinburgh, Royal College of Surgeons of England
Disclosure: Nothing to disclose.
Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center
Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
The Chief Editor would like to acknowledge the assistance of Dr Mohsina Subair, Postgraduate Resident, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India, in updating the review of this article.
Rigid Sigmoidoscopy
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