Rigid Sigmoidoscopy
Simulation
The simulator tests your ability to prepare for and perform rigid sigmoidoscopy.
Video
The video guides you through a step-by-step demonstration on how to set up and perform rigid sigmoidoscopy of a male or female.
Anatomy
The anatomy provides a detailed cross section of both female and male pelvic structures, including a 360-degree rotating coronal image to illustrate the key structures of the examination.
Text
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Step 1: Preparation
1.1. Tray Preparation
Before embarking on this procedure, be sure to set up your tray with the necessary equipment and/or medication.
Assemble the eyepiece and bellows. Attach the filter to the eyepiece, followed by attaching the bellows to the filter. Ensure that the light source is working and attach it to the eyepiece.
Attach a disposable bag to the tray for depositing your used non-sharp materials.
1.2. Patient preparation
Administer an enema half an hour to two hours before the procedure (see reference). This may not be necessary if the patient has just had a bowel motion.
Place the patient in the lateral position. The buttocks should be at the edge of the bed with the hips and knees flexed at 90 degrees. Various other positions can be used; the left decubitus position is the most common.
1.3. Operator preparation
Take universal precautions.
Double glove the dominant hand as a digital rectal examination needs to be done prior to the sigmoidoscopy.
Step 2: Perform a digital rectal examination
Visually inspect the anus and perianal area.
Lubricate your finger and perform a digital rectal examination to assess the rectum for pain, masses and bleeding, the rectovaginal septum in females, and the prostate in males.
Remove the outer glove from your dominant hand and discard it into the disposable bag.
NOTE
- If the patient does not tolerate the digital rectal examination due to pain, do not attempt to perform the sigmoidoscopy. The patient should have an examination under anesthesia, especially if a non benign lesion is suspected.
Step 3: Lubricate the sigmoidoscope
With the obturator within the sigmoidoscope, generously lubricate the tip of the obturator and the sigmoidoscope.
Step 4: Introduce the sigmoidoscope into the rectum
Ensure that the obturator is fully inserted into the sigmoidoscope.
Hold the sigmoidoscope so that the thumb or palm maintains pressure on the obturator during the introduction.
Separate the buttocks and gently insert the sigmoidoscope into the rectum. Aim initially towards the umbilicus and then towards the sacrum.
Gently insert the sigmoidoscope 8 to 10 cm (3 - 4 in.) into the rectum and then remove the obturator.
Step 5: Attach the eyepiece to the sigmoidoscope
Attach the eyepiece to the sigmoidoscope.
Close the window of the eyepiece completely.
Step 6: Advance the sigmoidoscope into the rectum
Whilst looking through the eyepiece, introduce air into the rectum using the bellows. This opens up the lumen of the rectum.
Align the sigmoidoscope with the lumen and gently advance it.
Introduce air at intervals to gradually open up the bowel lumen beyond the sigmoidoscope.
Continuously change the direction of the sigmoidoscope to keep within the lumen.
Note any pathology and the levels at which they are encountered.
If the view becomes obscured by fecal material, use a swab and biopsy forceps to clear it.
The rectosigmoid junction may be difficult to negotiate; if there is significant difficulty advancing the sigmoidoscope beyond this level, do not proceed.
Note the level that the sigmoidoscope has been able to pass to. This can be read off the markings on the sigmoidoscope.
NOTE:
- Do not advance the sigmoidoscope if the lumen is not visible.
- Do not use force to advance the scope.
- The aim of the procedure is to insert the sigmoidoscope into the rectum only as far as is safely possible; not the entire length.
- If the patient experiences discomfort, ensure that the sigmoidoscope is still aligned with the lumen, and release some of the air by opening the eyepiece window.
Step 7: Gently withdraw the sigmoidoscope
Gently withdraw the sigmoidoscope and biopsy any pathology, if indicated.
Before removing the sigmoidoscope completely, open the eyepiece window to allow the air to escape.
Step 8: Clean the patient
Wipe off the lubrication jelly. Offer the patient tissue paper and allow them the privacy to get dressed.
Place a sanitary pad or gauze between the buttocks if a biopsy was taken.
References
Retrospective study
1. Robinson RJ, Stone M, Mayberry JF. Sigmoidoscopy and rectal biopsy: a survey of current UK practice. Eur J Gastroenterol Hepatol. 1996 Feb;8(2):149-51. PMID: 8723420
Nonrandomized prospective studies
2. Takahashi T, Zarate X, Velasco L, Mass W, Garcia-Osogobio S, Jimenez R, Tellez O, Ponce-de-Leon S. Rigid rectosigmoidoscopy: still a well-tolerated diagnostic tool. Rev Invest Clin. 2003 Nov-Dec;55(6):616-20. PMID: 15011729
3. Mann CV, Gallagher P, Frecker PB. Rigid sigmoidoscopy: an evaluation of three parameters regarding diagnostic accuracy. Br J Surg. 1988 May;75(5):425-7. PMID: 3390671
