Rigid Sigmoidoscopy - The Procedure
Dr. George Orlay M.B., B.S., F.R.C.S., F.R.A.C.S.
FIGURE 1
Left lateral position (Sim's position)
The patient lies on the left side (viewed from above). The trunk across the
couch rather than parallel to its edge. The buttocks project over the edge
and the knees are drawn towards the chin.
FIGURE 2
If necessary, the bowel is emptied with a suppository.
Digital examination of the rectum always precedes sigmoidoscopy.
The sigmoidoscope is lubricated and then inserted with obturator
in direction of umbilicus (assistant points to umbilicus).
FIGURE 3
The direction changes into the hollow of the sacrum
with the obturator removed and penetration under direct vision.
The use of the bellows at this stage distends the rectum and
ensures that safe progress can be made in the lumen of the bowel.
FIGURE 4
To obtain full penetration, the sigmoidoscope must
follow the curve of the sacrum. Full rigid sigmoidoscopy may
be impossible on account of lateral angulation of the bowel into
the recto-sigmoid region.
FIGURE 5
Shows the directions negotiated in the coronal
plane. Lateral movement with the tip of the sigmoidoscope is
necessary to negotiate the valves of Houston and the recto-sigmoid
junction. If the latter causes pain, it should not be persisted
with (the dotted line represents possible angulation).
Conditions
seen in the Rectum and lower Sigmoid Colon
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