The patient had redundant perianal skin from old hemorroid disease.

Position. IV was in place. She was then turned to a left lateral Sims’s position. Perianal area was Inspected. The patient had redundant perianal skin from old hemorroid disease. No evidence of active hemorrhoid tissue. There was no evidence of anal fissure. There was good sphincter tone. No palpable masses. Liquid stool in the rectal pulla was hemoccult negative. Rigid sigmoidoscopy was introduced to 15 cms. The rectum and anal canal was inspected. The mucosa appeared normal. There was normal distention of the bowel with insufflation and the submucosal vascularity appeared normal. The Olympus colonscope was then introduced. It was easily passed beyond the rectum into the sigmoid colon. This was slightly redundant and took several minutes to pass the scope beyond this area into the descending colon which was easily traversed as well as the splenic flexure and the transverse colon. The area of the old anastomosis was inspected and found to be widely patent. The small bowel just proximal to the anastomosis appeared normal. There was no evidence of stricture, recurrence or edema in the area. The area also distended normally with insufflation. The scope was then slowly withdrawn through the transverse colon, splenic flexure, descending colon, sigmoid colon and rectum. A few scattered diverticula were identified in the sigmoid colon and descending colon other than that the bowel appeared absolutely normal. As the cope was slowly withdrawn insufflation suctioned through the colonoscopypatient required 5 mg. of Valium IV during the procedure. She tolerated it well. Was discharged back to the Same Day Surgery Unit to have her IV discontinued, to be advanced on diet and ambulation. She routinely sees Dr. Nespola and he has been following her closely for her elevated CEA and there does not appear o be any cause for concern of recurrence. She was discharged to return to his care.