Case 1: Zhou xx, male, 56 years old. Admitted to the hospital with the main complaint of "mass prolapsed from the anus after defecation for 10 years", and was admitted to the hospital for surgical treatment with the diagnosis of "mixed hemorrhoids". After admission, the physical examination was completed, such as blood routine, eight immune items, etc., and no contraindications to hemorrhoid surgery Mixed hemorrhoids external stripping and internal ligation under local anesthesia, postoperative antibiotics, Chinese medicine sitz bath and corresponding anorectal dressing treatment, healed and discharged after half a month. Symptoms of stool with pus and blood appeared in the stool 1 month after discharge. Fiber colonoscopy was performed. A 50cm colon tumor at the local anal margin, local tissue biopsy, pathological diagnosis: colon adenocarcinoma. He was admitted to the hospital for surgical treatment, healed and discharged after half a month.
Hidden reasons and feelings: The main complaint of the patient was "the mass in the anus prolapsed 10 years after defecation". The specialist examination showed that the hemorrhoids near the dental line were obvious, and the hemorrhoids in the anus prolapsed from the anal margin with the withdrawal of the anoscope. No blood on the finger cuff, and the patient has no symptoms and manifestations of rectal cancer such as frequent stools, blood (dark blood, pus blood, etc.), weight loss, etc., the diagnosis of "mixed hemorrhoids" is clear, no surgical contraindications, local anesthesia The mixed hemorrhoids were removed and internally ligated, and the patient recovered after the operation. One month later, stool with pus and blood appeared, and the intestinal tumor was confirmed under fiber colonoscopy, which was confirmed pathologically. The patient has obvious symptoms of hemorrhoids and no obvious corresponding symptoms of rectal cancer, but obvious tumors can be seen under fiber colonoscopy. It is necessary to perform fiber colonoscopy for different patients.
Case 2: Bai xx, male, 60 years old. "Stool bleeding for 1 week" as the main complaint, admission to the hospital with "lower gastrointestinal bleeding pending investigation", after admission, complete the admission-related physical examination, symptomatic treatment, and perform fiber colonoscopy to diagnose "colon ulcer", and it is recommended to review again In colonoscopy, the patient's bleeding symptoms improved significantly after 3 days of treatment. He gave up the treatment. After 1 month, the bleeding symptoms appeared again. The colonoscopy was performed again. Colon tumors were found and the pathological diagnosis was colon adenocarcinoma. The patient was admitted to the hospital for surgical treatment and was discharged after recovery.
Hidden reasons and feelings: The patient has obvious symptoms of stool bleeding, no frequent stools, no weight loss and other obvious symptoms of intestinal tumors. No intestinal tumors were found in the first examination of fiber colonoscopy. After treatment, the bleeding symptoms have improved significantly. Colonoscopy, but because the patient gave up treatment, he thought he was in a good condition and no examination was needed. After 1 month, he had bleeding symptoms again, and the colonoscopy was performed again to confirm the existence of the tumor and surgical treatment.
Case 3: Yang xx, female, 58 years old. The main complaint was "informed stool with blood in the lower abdomen with pain and discomfort for half a month". He was admitted to hospital for treatment with "chronic colitis", "diabetes", and "schizophrenia". The local fiber colonoscopy diagnosed at the time of admission: chronic colitis. No intestinal ulcers and tumors were found under colonoscopy. Symptomatic treatment after admission, the symptoms improved significantly. After the patient was discharged from the hospital, he underwent fiber colonoscopy again at the provincial hospital after discharge. A colon tumor was found, and related physical examinations were performed. The tumor was malignant. It was in the middle and late stages and could not be treated with conservative symptomatic treatment.
Hidden reasons and thoughts: When the patient was admitted to the hospital, no intestinal tumors were found in the local fiber colonoscopy. At the same time, the patient had no obvious symptoms of intestinal cancer, no symptoms such as frequent blood in the stool, pain and discomfort in the lower abdomen, symptoms improved after medication; fiber colonoscopy was performed again On examination, colon tumors were found, which had reached the middle and late stages. There was no surgical significance and conservative treatment.
The significance of electronic colonoscopy:
Electronic colonoscopy has a decisive role in the diagnosis and treatment of ulcer disease, gastrointestinal bleeding, colorectal cancer, colorectal polyps, various enteritis and other diseases.
Electronic colonoscopy can be performed under the following conditions without contraindications.
1. Unexplained lower gastrointestinal bleeding.
2. Chronic diarrhea of unknown cause.
3. Abdominal masses of unknown cause cannot be excluded from lesions of the large intestine and terminal ileum.
4. Unexplained middle and lower abdominal pain.
5. Suspected benign or malignant colon tumors, who cannot be diagnosed by X-ray examination.
6. Suspected chronic intestinal inflammatory disease.
7. Barium enema or bowel examination finds abnormalities, and the nature and scope of the lesions need to be further clarified.
8. Determine the scope of lesions before colon cancer surgery, and follow-up after colon cancer and polyps surgery.
9. Unexplained low intestinal obstruction
Features of electronic colonoscopy
Electronic colonoscopy is currently the best choice for diagnosing rectal and colon lesions. It transmits images of colon mucosa to the computer processing center through an electronic camera probe installed at the front end of the colonoscope, and then displays it on the monitor screen for observation. Small changes in the mucosa of the large intestine. Such as cancer, polyps, ulcers, erosions, bleeding, pigmentation, varicose and dilation, hyperemia, edema, etc., the images are clear and lifelike.
The electronic colonoscopy can also be sent into the biopsy forceps through the instrument channel of the colonoscope to obtain tissues the size of rice grains, and perform pathological biopsy tests or other special staining, and the histological characterization of the nature of mucosal lesions, such as the degree of inflammation, the degree of differentiation of cancer, etc. Grading helps to understand the severity of the disease, guide the formulation of the correct treatment plan or judge the treatment effect. Through the enteroscope instrument channel, some diseases or lesions of the colon such as polyps, bleeding, foreign bodies, etc. can be treated under endoscopic treatment.