Flexible Sigmoidoscopy: Overview, Indications, Procedure
Flexible sigmoidoscopy is a colorectal cancer screening technique that detects 50% to 60% of colon cancers. With flexible sigmoidoscopy, the inner lining of the rectum and the last 2 feet of the distal colon can be visualized; 60-cm sigmoidoscopy is preferred.
● Rectal bleeding
● Positive Hemoccult test
● Mass on digital examination
● Lower abdominal pain and cramping
● Change in bowel habits
● Foreign body in the rectum
● Itching—anal or perianal
● Pain—anal or perianal
● Acute abdomen
● Cardiovascular or pulmonary disease
● Suspected perforation
● Recent pelvic or abdominal surgery
● Coagulation disorders
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● Flexible sigmoidoscope—60 cm (Fig. 113.1)
● Light source
● Two pairs of gloves—nonsterile
● K-Y jelly or 2% lidocaine jelly
● 4 × 4 gauze—nonsterile
● Absorbent pads—nonsterile
● Culture tubes
● Emesis basin
● Sigmoidoscopy report sheet
● Position the client in the left lateral decubitus position.
● Right leg flexed at the hip and knee
● Put on two pairs of gloves.
● Lubricate the second or third digit of the dominant hand.
● Perform a digital examination to dilate the sphincter.
● Lubricate the anus and the tip of the sigmoidoscope.
● Lubricate the distal half of the sigmoidoscope but not the lens.
● Remove the top pair of gloves and dispose of them.
● Separate the gluteal folds.
● Insert the scope gently 8 to 10 cm.
● Activate the light, suction, and air.
● With the right hand—Advance the scope.
● With the left hand—Work the controls on the scope.
● Open the colon by insufflating with a small amount of air, and advance the scope gently.
● Do not use too much air—this causes discomfort.
● Advance the scope using one of the following techniques
● Hook and pullout—used to straighten the colon
• Hook mucosal fold, and pull back to straighten the colon.
● Dither and torque—used to shorten the colon
• Alternate insertion with slow partial withdrawal to pleat the colon.
• Twist the sigmoid shaft clockwise or counterclockwise with a forward and/or backward motion.
• Observe for natural landmarks and abnormalities.
● Take a biopsy specimen of all abnormal areas and put in culture tube for biopsy.
● Withdraw the sigmoidoscope slowly, reinspecting the mucosa.
● When in the rectal vault, retroflex the tip of the scope to visualize the distal rectum.
● Straighten the tip, and gently withdraw the scope.
● Cleanse, sterilize, and store per manufacturer’s instructions.
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● The following may be expected but will resolve quickly.
● Abdominal cramping if a biopsy specimen was obtained
● Feeling of fullness, distention, or flatus
● No bowel movement for several days
● Minor bleeding
● No special diet is recommended after the procedure.
● Watch for signs of infections, such as
● Elevated temperature
● Increased or prolonged rectal pain
● Green or yellow drainage
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National Cancer Institute. Fact Sheet—Tests to Detect Colorectal Cancer and Polyps. Date
Reilly HF. Primary care use of the flexible sigmoidoscope to detect colorectal cancer and its
precursors. Primary Care Cancer, 1994;14(5):41–45.
Flexible sigmoidoscopy. YouTube.
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