Technically difficult colonoscopy, a non-radiologic sign of sigmoidal obstruction: value of sigmoid colectomy for intractable symptoms.

Technical difficulty in passing the colonoscope was assessed in 371 patients undergoing 627 colonoscopies during 1989-91 and were graded as 0: no difficulty and cecum reached (71.43%); 1: difficult but cecum reached (20.22%); 2: difficult and cecum not reached although lumen beyond seen (4.85%); and 3: difficult and cecum not reached as lumen beyond could not 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 disturbed bowel habits for a mean of 30.5 months, unresponsive to conventional medical measures, and who also had a grade 2 or 3 sigmoidal obstruction, elected to undergo sigmoid colectomy. Operative and pathologic studies showed that the primary cause was fixation of the sigmoid colon to the pelvis in two or three loops by adhesions from previous pelvic surgery, endometriosis, ovarian cyst, or diverticulitis. All patients had relief of symptoms that was maintained during the 1-9 year follow-up.