Importance of retroflexion in the rectum during colonoscopy.

A 42-year-old male patient consulted several times for recurring episodes of bleeding per rectum. An anal source was clinically suspected from the beginning due to the pattern of blood expulsion after passing stools. The patient had been studied for this reason and had undergone two colonoscopies under deep sedation with propofol. Small size hemorroides were observed and different kinds of treatments were applied. As bleeding per rectum continued, the patient was referred to Surgery. In physical exam (anal inspection and anoscopy) the surgeon did not remark enough hemorroidal engorgement as to prescribe an operation. He ordered a third colonoscopy exam. In this occasion it was performed with the patient unsedated. In this third procedure, with the endoscope in retroflexion in the rectum, a polyp with stalk was observed located a few centimetres above the pectinate anal line (Fig. 1). The examination continued until the cecal pole and no more lesions were found. Finally, snare polyp removal was performed (Figs. 2 and 3). No complications occurred. Pathologic diagnosis was of a 1.7 cm of maximun diameter adenomatous polyp specimen with some foci of moderate dysplasia. Resection limit was clearly demarcated. Importance of retroflexion in the rectum during colonoscopy