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Case 85: Unusal view at endoscopy

A first year registrar is performing a colonoscopy and is confused.

1. What view has been attained by the registrar?

A retroflexed view in the rectum looking at the anal canal from above. See the scope as a black tube superiorly.

2. Is this maneouvre indicated in usual circumstances?

Yes, it does have the small risk of rectal perforation if not performed delicately, however it shows a good view of the internal haemorrhoidal plexus and any polyps etc just above the anorectal ring. These problems can be easily missed, especially if a digital rectal examination is not performed at the beginning of the procedure. This part of the colonoscopy is advocated by the American Gastroenterological Association.

American Gastroenterological Association endoscopy guidelines