TECHNICALLY DIFFICULT COLONOSCOPY, A NON-RADIOLOGIC SIGN OF SIGMOIDALOBSTRUCTION - VALUE OF SIGMOID COLECTOMY FOR INTRACTABLE SYMPTOMS

Technical difficulty in passing the colonoscope was assessed in 371 pa tients undergoing 627 colonoscopies during 1989-91 and were graded as 0: no difficulty and cecum reached (71.43%); 1: difficult but cecum re ached (20.22%); 2: difficult and cecum not reached lumen beyond seen ( 4.85%); and 3: difficult and cecum not reached as lumen beyond could n ot be seen (3.5%). Frequency of patients with chronic lower abdominal pain and/or disturbed bowel habits in each grade increased as grade of obstruction increased: 0 (25.66%), 1 (36%), 2 (77.77%), and 3 (100%). During 1983-91, 54 Patients with lower abdominal pain and/or disturbe d bowel habits for a mean of 30.5 months, unresponsive to conventional medical measures, and who also had a grade 2 or 3 sigmoidal obstructi on, elected to undergo sigmoid colectomy. Operative and pathologic stu dies showed that the primary cause was fixation of the sigmoid colon t o the pelvis in two or three loops by adhesions from previous pelvic s urgery, endometriosis, ovarian cyst, or diverticulitis. All patients h ad relief of symptoms that was maintained during the 1-9 year follow-u p.