Diagnostic Proctoscopy
All general practitioners should be familiar with
diagnostic proctoscopy.
The simplest diagnostic proctoscope as shown below is a cyclindrical tube with
a handle at one end and an obturator for insertion into the anal canal.
It should be 2cm or more in diameter for adequate visual inspection.
There are many other types of proctoscope which can also be used therapeutically.
They have distal angles or slits.
INDICATIONS - All proctological complaints
CONTRAINDICATIONS - Nil
BOWEL PREPARATION - Nil
ASSISTANCE - Nil
POSITION OF PATIENT - Left lateral position
Left lateral position
ANAESTHESIA
The majority of patients do not require anaesthesia.
If pain results the examination is terminated and
proctoscopy is carried out under general anaesthesia or sedation
and pudendal block regional anaesthesia.
TECHNIQUE
The proctoscope with obturator is well lubricated
and held in the right hand, as shown below.
It is slowly inserted
A. Towards the patient's umbilicus
B. Into the curve of the sacrum
The left hand now holds the proctoscope and the
obturator is removed with the right hand.
Obsverations are made as the proctoscope is slowly
withdrawn.
NORMAL FINDINGS
From above down.
- Typical colorectal mucosa - pink in colour, with numerous
folds.
- Transitional zone approximately 1cm. Change from pink to
purple with 8-14 vertical columns of Morgagni.
- Dentate line. The most important structure which demarcates
ectoderm from endoderm, acute sensation from absent sensation
and stratified epithelium from mucosa. It has a serrated appearance
with crypts and papillae.
- The region of modified skin or anoderm is also about 1cm
in width.
SOME ABNORMAL FINDINGS
FIGURE 1
Prolapsing greatly hypertrophied anal papilla - anal
polyp
FIGURE 2
Inflamed anal papilla
FIGURE 3
Prolapsing internal haemorrhoid
FIGURE 4
Extensive villous adenoma
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