A young office executive, on tour, presents wih bright red painless bleed since 7 days and abdominal pain. External and perrectal examinations are normal. As attending general practioner what will be your next step: (A) Proctoscopy, (B) Do a barium enema, (C) Refer to surgeon for sigmoidoscopy, (D) Refer to gastroenterologist for colonoscopy
Answer is A. Proctoscopy, performed with the patient in the same position, allows a detailed inspection of the distal rectum and anal canal. Minor procedures can also be carried out through this instrument, e.g. treatment of haemorrhoids by injection or banding (see below) and biopsy. Asking the patient to bear down on slow withdrawal of the proctoscope may reveal a descending intussusception Ref: Bailey & Love&;s Sho Practice of Surgery,E25,Page-1243,1244