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Case 83: Endoscopic appearance

A 62 year old man is having an endoscopic procedure.

1. What procedure is being performed?

A Colonoscopy

2. Where is the scope?

In the right colon looking at the ileocaecal valve (top left) and the caecal pole in the distance.

This appearance may be quite obvious to an experienced endoscopist however, even then, the 2 dimensional appearance can be misleading. To confirm that the entire colon has been visualised it is important to observe the other anatomical features of the caecum. The three to remember are the ileocaecal valve, the triradiate folds of the caecum and the appendicoele orifice. Transillumination in a thin patient is unreliable, but can be used as a rough guide to position within the colon. The definitive way to know you are in the caecum is to negotiate the scope into the terminal ileum and view its characteristic velvety mucosa.