[Emergencies in colorectal diseases: role of the endoscopist]. / Le urgenze nella patologia del colon-retto: il ruolo dell'endoscopista.

ABSTRACT

In some emergency situations of colo-rectal pathology, especially those characterized by hemorrhaging, the endoscopy has acquired, with the passing of years, a fundamental role both from the diagnostic and the therapeutic point of view. In no more than 25% of the lower intestinal tract hemorrhages, the clinical picture does have the signs of an emergency. The diverticula, IBD and angiodysplasias are primarily responsible for rendering these characteristics. Even when possible problems concerning an accurate intestinal cleaning can arise, a correct diagnosis is possible at least in seven cases out ten. When the colonoscopy isn't conclusive and the bleeding persists may be recommended the selective arteriography (helpful also in hemorrhages lower than 0.5 ml/min). Also in cases of acute obstructive syndrome the colonoscopy, taking advantage of the direct view of the lesion, can give a correct diagnosis, sometimes supported by the histologic examination. Regarding the operating capacity of the method, the endoscopy can resolve minute and localized bleeding lesions. The Argon or NdYAG laser photocoagulation is widely used. Recently BICAP and heater probe methods have been developed, which aveld the problem connected to the HF electrocoagulation. A very efficacious and simple method is that of injecting 110.000 adrenalin, 1% polidocanol, absolute ethanol or hypertonic solution around the lesion. The scarred strictures are those more easily and safely treated by pneumatic dilatation or (limited to the rectum-sigmoid) by Savary sounds. In the volvulus or bowel invagination, just by having the endoscope goes up in the lumen, often normal condition settles again. In the Ogilvie's syndrome you can deflate the cecum with an aspirator or more simply by positioning a tube above the hepatic flexure, with 85% success. In the malignant strictures the debulking of tumor mass by laser treatment, sometimes followed by dilatation, may be preparatory to the surgery or purely palliative. Finally the extraction of foreign bodies must be performed, in order to obtain a relaxed anal sphincter, in general anaesthesia or by a previous rigid rectoscope dilatation.