Sunday, May 5, 2013

New Indication for Colonoscopy: High Value Target Captured.


This past week, I had a once-in-a-career event.  Indeed, if I didn’t already author a blog, this episode would have been the catalyst to begin one.   As I write this, I am not certain which category label to assign to this post.  I will likely include it in General Whistleblowing rather than create a new category called Search and Rescue.

Gastroenterologists are not just healers of the alimentary canal.  Yes, we are consumed with issues of mastication, salivation, rumination, trituration (GI power word), secretion, digestion, propulsion and elimination.  But, we are so much more than this.  We are poised to serve humanity in so many ways beyond medicine.
  
The colonoscope is mankind’s Holy Grail. 

Please study the photograph below carefully.  When we were medical students peering at a chest x-ray while the attending physician hovered behind us, we were told that “the answer is on the film”.  Of course, we always missed the diagnosis.  We would focus on the heart and lungs and ignore a lesion that was in the shoulder bone at the periphery of the film.  So, dear readers, study this photo.  As a gesture of extreme generosity, I will disclose that this is a photograph of the cecum, which is the blind sac at the upper part of the large intestine where the appendix originates.  “The answer is on the photograph”.



Three weeks before this individual enjoyed the pleasure of colonoscopic intrusion, he swallowed an item that was of great personal value.  How valuable?  Valuable enough that this man strained his stools during this period with the hope of capturing the buried treasure.  Nice visual, huh?

An astute nurse, who knew the lost item’s identity, thought that what is seen in the above photograph was a bulls-eye.  The excitement in the endoscopy suite was a crescendo.   Was this stowaway in the cecum a piece of food or something far more desirable?

I then relied upon decades of medical experience for guidance.   I elected to retrieve the item and subject it to strict scrutiny.  I passed a gastroenterologist’s version of a miniature butterfly net through the colonoscope and performed a successful extraction.

Once we cleaned it up a bit, it was easy to recognize this man’s porcelain dental crown.  Once he awoke, he was joyful to be reunited with this evasive escapee.



I’ve removed thousands of polyps from the colon.  I’ve taken thousands of biopsies from all kinds of lesions.  I’ve seen worms wriggling inside a colon that became their new home.  I’ve used the colonoscope to investigate bleeding, diarrhea, bowel issues and abdominal pain.  But, with this man, I enjoyed a singular accomplishment.  It was my crowning achievement.

Photos published with permission.


1 comment:

Dr.Redwan said...

Impressed to know the new indication of colonoscopy, thanks

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