Rektoskopi
Özet
Rektoskopi, alt gastrointestinal sistemin incelenmesinde kullanılan tarihi bir yöntemdir ve modern kolonoskopinin gelişmesiyle kullanımı azalsa da spesifik durumlarda önemini korumaktadır. Bu makalede, 1895'te Howard Kelly tarafından geliştirilen rijid cihazlardan günümüzdeki esnek sistemlere kadar olan tarihsel süreç ele alınmaktadır. Günümüzde rektoskopi; anorektal kanamalar, tümörler, fistüller, yabancı cisim çıkarılması ve rektal kanserlerin mesafe tayini gibi hem tanısal hem de tedavi edici amaçlarla uygulanmaktadır. Şüpheli perforasyon durumlarında kesinlikle kontrendike olan bu işlem; akut kolit, nekroz ve koagülopati gibi durumlarda ise rölatif risk taşır. Cihaz temel olarak bir ışık kaynağı ve endoskopik enstrümandan oluşur; anaskop, proktoskop ve 30 cm uzunluğundaki standart rektosigmoidoskop gibi çeşitleri bulunur. Genellikle sedasyonsuz, SIMS veya diz-dirsek pozisyonunda gerçekleştirilen işlemde, lümen hava ile dilate edilerek yaklaşık 15-20 cm’lik bir alan incelenir. Nadir görülmekle birlikte, biyopsi sonrası kanama veya nötropenik hastalarda bakteremi gibi komplikasyonlar gelişebilir; hastaların bir kısmında ise işlem sırasında hafif veya orta dereceli ağrı ve huzursuzluk hissi oluşabilmektedir.
Rectoscopy is a historical method used for examining the lower gastrointestinal system, and although its use has decreased with the development of modern colonoscopy, it retains its importance in specific clinical cases. This article covers the historical process from the rigid devices developed by Howard Kelly in 1895 to today’s flexible systems. Currently, rectoscopy is applied for both diagnostic and therapeutic purposes, such as anorectal bleeding, tumors, fistulas, removal of foreign bodies, and determining the precise distance of rectal cancers. The procedure is strictly contraindicated in cases of suspected perforation, while it carries relative risks in conditions like acute colitis, necrosis, and coagulopathy. The device essentially consists of a light source and endoscopic instruments, including variants such as the anoscope, proctoscope, and the standard 30 cm rectosigmoidoscope. Typically performed without sedation in SIMS or knee-chest positions, the procedure involves dilating the lumen with air to examine an area of approximately 15-20 cm. Although rare, complications such as post-biopsy bleeding or bacteremia in neutropenic patients can occur; some patients may experience mild to moderate pain and discomfort during the procedure.
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