HOME > operative reports > Gastroenterology

operative reports

Gastroenterology

PROCEDURE: Colonoscopy and Biopsy

After informed consent, the patient received Demerol 100 mg intravenous incrementally slowly, Versed 3 mg intravenously slowly, with the benefit of electrocardiogram, pulse oximetry and blood pressure monitoring. The patient was examined with the Olympus video colonoscope.

FINDINGS: External examination: No fissure, fistula or external hemorrhoid noted.

Digital examination: Normal rectal sphincter tone, no masses were palpated, no tenderness was elicited.

Flexible examination: The mucosal lining of the rectum revealed mild patchy erythema to a minimal degree. A fine submucosal vascular branching pattern was noted. In the distal sigmoid colon, there was mild edema; this area was biopsied for histologic analysis. The remainder of the sigmoid colon, descending colon, transverse colon, ascending colon and cecum were well visualized, despite retention of a moderate amount of liquid and semisolid stool. Turning, suctioning, positioning and lavaging the patient's colon revealed no gross lesions.

The terminal ileum was entered and examined for approximately 10 cm. There was marked apparent increase in lymphoid hyperplasia with several areas of erythema, which were biopsied for histologic analysis.

Upon withdrawal, mildly inflamed internal hemorrhoids were noted.

PROCEDURE: Endoscopic Retrograde Cholangiopancreatography (ERCP)

After informed consent was obtained, the patient was placed in the left lateral position, premedicated by the anesthesiologist.

Under direct vision, side-viewing video duodenoscope was passed into the esophagus and into the stomach. The stomach and duodenum were normal.

Inspection of the ampulla revealed papillitis with a beefy-red papilla. Cannulation revealed a normal pancreatogram. Separate orifice for the common duct revealed a markedly dilated common bile duct, intrahepatic ducts, and common hepatic duct measuring at least 1.6 cm. There was no evidence of retained stone. Filling of the cystic duct remnant was unremarkable with a clip seen at the cystic duct. There was no evidence of stone.

In the distal common bile duct, there was a smooth tapering at the area of the sphincter mechanism, benign in appearance. In view this, it was felt that a sphincterotomy should be performed in view of the likelihood of a sphincter of Oddi dysfunction or papillary spasm in the setting of significant papillitis. Therefore, a protector wire was placed through the diagnostic catheter. A wire-guided sphincterotome was then placed over the protector wire and into the common duct. Films were taken for confirmation.

A controlled sphincterotomy was then performed in the usual fashion without difficulty. Bile was seen flowing and the duct was open. A bowed sphincterotome easily moved freely in and out of the papillary orifice, suggesting adequate sphincterotomy size. There was no evidence of complication.

The endoscope was then removed. The patient tolerated the procedure well.

PROCEDURE: Esophagogastroduodenoscopy (EGD)

Esophagus: This area was well visualized in its entirety and appeared macroscopically normal. A 1.5- to 2-cm hiatus hernia was present. No macroscopic abnormalities were noted in the distal esophagus. A biopsy was taken approximately 5-cm proximal to the macroscopic gastroesophageal junction.

Stomach: The antrum was normal. On retroflexion, the cardia was minimally incompetent. The fundal mucous lake area and body of the stomach were normal. Biopsies were taken from the antrum and body of the stomach.

Duodenum: There was a moderate degree of duodenitis in the bulb. The postbulbar and descending duodenal areas appeared normal. A biopsy was taken from the bulb.