Original Scientific Articles /Articles Originaux
EXPERIENCE WITH COLONOSCOPY IN THE RIVERINE SOUTHWESTERN NIGERIA EXPERIENCE AVEC LA COLOSCOPIC EN MILIEUX RIVERAINS SUD-QUEST DU NIGERIA 1
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*OBONNA GC , AROWOLO AO , AGBAKWURU A . Abstract Background: Colonoscopy is useful for diagnosis, treatment and surveillance of anal and colorectal lesions. It affords a good, less invasive and tolerable way to see and access the large intestine. Aim and Objective: To determine the indications, finding and diagnosis at colonoscopy in a riverine setting in Southwestern Nigeria. Type of study: Descriptive cross sectional study. Patients and Methods: Patients who presented in the State Specialist Hospital, Okitipupa and requiring colonoscopy in their management between January 2011 to April 2013 were included in this study. They were reviewed and their demographic and clinical data, indications for colonoscopy, the findings and the pathological diagnosis were entered in a proforma. Results: Colonoscopy was done in 100 patients out of which seventy seven (77%) were males and 23 (23%) were females. The indications were frank lower gastrointestinal bleeding 55 (55%) chronic diarrhea (11%), chronic constipation10(10%), occult gastrointestinal bleeding (7.0%), lower abdominal and anal pain 4 (4.0%), queried anorectal cancer 3 (3.0%) and enterocutaneous fistula 1(1%). Colonoscopic findings, include, normal finding 24(24%) colitis 24 (24.0%), hemorrhoid 20(20.0%), Anal fissure 16 (16.0%) colonic cancer 5 (5.0%), anorectal cancer 4 (4.0%), caecal cancer 2 (2.0%) faecal impaction 2 (2.0%), anal wart 2 (2.0%) , polyps 1 (1.0%) and anal fistula 1 (1.0%). The diagnostic yield was 76%. Conclusion: Bleeding from the lower gastrointestinal tract was the commonest indication for colonoscopy and the most frequent pathology was amoebic in the riverine Southwestern Nigeria. Key words: Colonoscopy, Amoebic colitis, Haematochezia, Southwest Nigeria. Résumé Contexte: La coloscopie est utile pour le diagnostic, traitement surveillance de lesoinsColorectals et anales. Elle procure un bon, moins invasif et tolerable moyen de voir et avoir acces en gros intestin But et objectif: Pour determiner les indications, conclusions et diagnostics a la coloscopie dans les milieux riverains an sud ouest du Nigeria. Type d'etude: Etude transversale descriptive par observation. Patients Et Methodes: Les patients presentes a l'hopital des specialists de l'etat (State Specialist Hospital), a Okitipupa, et demandant la coloscopie dans leur gestion entre Janvier 2011, Avril 2013 etaient inclus dans cette etude. Ils etaient concultees et leur diagramme, demograpgique, clinique, indications pour coloscopie, les conclusions et le diagnostic pathoclogique sont recueillis dans un proformat.
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Resultats: La coloscpie etait faite sur 100 patients don't soixante dix sept pour cent (77%) etaient des homes et vingt trias pour cent (23%) etaient des femmes. Les indications etaient franc interieur saignements gastro intestinaux (55%), diarrhee ehronique, vor (11%), constipation chronique (10%), occulte saignement gastro intestinaux (7.0%), douleurs anales et du bas-ventre (4.0%), cancer anorectal interroge (3.0%) et fistules entero-cutaneas (7%), les conclusions coloscopiques, incluses, donnee normale (24%), colite (24.0%), hemorrhiode (20%), scissure anale (16%), cancer du colon (5.0%) cancer ano-rectale (4%), cancer du caecum (2%), impaction tecale (2.0%), verrue anale (2%), polypes (1.0%) et fistule anale (1%). Le rendement du diagnostic etait de 76% Conclusion: Les saignements de gastro intestinaux de il appareil disgestif etaient de cas de plus revele pour la coloscopie et la plus frequente pathologie etait l'amibe dans les milieux riverains au sud ouest du Nigeria. Mots Cles: Coloscopie colite amibiase, haemetochezia sud ouest Nigeria.
Introduction
Introduction
Treatment of some rectal and colonic pathologies could be effected even during a diagnostic colonoscopy and could be safely carried out on out-patient basis.1,2
le traitment de certaines pathologies rectales et du colon devrait etre effectue meme pendant un diagnostic coloscopique et devrait etre. Soigneusement effectue pique est recommandee la surveillance de detection du cancer colorectal pour ceux a risqué comme une procedure de suivi operationnel dans l'ordre de detecer la recurrence tres tot.
Surveillance colonoscopy is recommended for early detection of colorectal cancer for those at risk and as a post-operative monitoring procedure in order to detect recurrence 2,3 early. Despite the need for colonoscopy in Nigeria, it is still not in common use, so not much work 4, has been reported using this diagnostic tool . This could lead to missed diagnosis with the attendant high morbidity and mortality. . In order to determine the indications and findings in this riverine area, we studied hundred colonoscopies over a two years and four months period at our endoscopy unit. 1
state Specialist Hospital, Okitipupa,ondo State, Nigeria. obafemi Awolowo University Teaching Hospital, Osun State, Nigeria.
2
E-mail: [email protected] *Correspondence Grant support: None Subvention de soutien: Aucune Conflict of Interest: None Conflit d'intérêts: Aucun
Malgre le besoin de la coloscopie au Nigeria, il n'est pas encore en emploi general peu de travaux ontete rappotes utilisant la outils du diagnostic. Ceci pourrait conduire a des echecs diagnostiques avec un taux eleve de morbidite et de mortalite. Dans l'ordre de determiner les donnees et conclusions dans ces milieux riverains nous avons etudie cent coloscopies sur une periode de deux ans et quatre mois dans notre unite d'endoscopie. Materiels et Methodes: Suivant l'information recent tous les patients referes pour la coloscopie a l'hopital des specialistes de l'Etat a Okitipupa, Etat d'Ondo, Nigeria entre Janvier 2011 et Avril 2013 ont forme le cible groupe de cette etude. Leur diagramme demographique et clinique tout comme les donnees closcopiques, traintement et resultat etaient recueillis dans un pro-format.
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Experience With Colonoscopy In The Riverine Southwestern Nigeria Experience Avec La Coloscopic En Milieux Riverains Sud-quest Du Nigeria
Materials and Methods Following informed consent, all the patients referred for colonoscopy at the State Specialist Hospital Okitipupa, Ondo State, Nigeria between January 2011 and April 2013 formed the study group in this study. Their demographic and clinical data as well as the colonoscopic findings, treatment and outcome were recorded in a proforma. All the colonoscopies were done with a Pentax video colonoscope with a light source color temperature: ≥3200k, color rending index :≥85%, illuminance:≥7x 104 Lux with a pump pressure of 40-60 kpa while the flux was ≥5 L / min. Colonoscopy requires a full bowel preparation accompanied by fasting and sedation prior to commencing the procedure. Bowel preparation regimen consisted of ingestion of a total of 40pills of sodium phosphate (visicol), with 5 pills taken every hour with a full glass of water. When the pills are not available we used the liquid sodium phosphate solution (fleet's phospho- soda) 45ml taken twice 8- 12 hours apart. Patient is placed on liquid diet during the period of this mechanical bowel preparation. After establishing an intravenous line, 10mg of diazepam and 30mg of pentazocine were administered to achieve sedation and analgesia respectively. Digital rectal examination is a sine qua non before starting the standard process of colonoscopy. Results Out of a total of 100 patients, 77 (77%) were males while 23 (23%) were females giving a male to female ratio of 3.5:1. Their age ranges from 15 to 86 years. The age distribution is as shown in Fig. 1. The indications for colonoscopy include frank bleeding per rectum in 55 (55%) patients, chronic diarrhea in 11 (11%), chronic constipation in 10 (10%), suspicion of colonic cancer in 9 (9%) patients, tarry black stools in 7 (7%), lower abdominal /anal pain in 4 (4%),suspicion of anorectal cancer in 3(3%) and enterocutaneous fistula in one(1%) patient as shown in Fig. 2. 65
Toutes les coloscopies etaient faites avec PENTAX video coloscope avec une source de lumiere coloree, temperature > 3200k, couleur indice dechirant > 85%, illuminance > 7x104 lux avec une pression de la pompe de 40-60 kpa pendant que le flux etait > 5L/mm. La coloscopie demande une totale preparation de L'intestin accompagnee de jeune et sedation avant de commencer la procedure. Le traitement de la preparation de l'intestin consiste a avaler un total de 40 comprimes de phosphate de sodium (visicol) prise de comprimes par heure avec un verre d'eau. Quand les comprimes sont introuvables nous utilisons la solution de phosphate de sodium liquide ( fleet's phosphate soda) 45ml prise deux fois entre 8 et 12 heure de temps patient plac sous la perfusion pendant la periode de son mecanisme de preparation de l'intestin. A pres une intervention intraveineuse, 10mg de diazepam et 30mg de pentazoane etaient administers pour achiever la sedation et lanalgesie respectivement. Le touches rectal est un “sine quanon” avant de debut proprement diat de a coloscopie. Resultats: Sur un total de 100 patients 77% etaient hommes don't femmes 23% avec donnee un homme pour une femme 1% poue 3-5% (ratio 3:5:1) leur classe d'age est de 15 a 86 ans. La repartition d'age est selon la fig.1 Les donnees poue la coloscopie inclus franc saignement par rectum sur 55% de patients, diarrhea chronique dans 11%, constipation chronique dans 10% soupcon de cancer du colon dans 9%, selles noires dans 7%, douleurs anales et du bas ventre dans 4%, soupzon du cancer ano-rectal dans 3% et fistule entrocutanee dans 1% de patient montres dans la fig.2
JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NO 2, APRIL – JUNE 2012
Experience With Colonoscopy In The Riverine Southwestern Nigeria Experience Avec La Coloscopic En Milieux Riverains Sud-quest Du Nigeria
The following were the colonoscopic findings: normal mucosa in 24(24%) patients, colitis in 24 (24%), hemorrhoids in 20 (20%), anal fissure in 16 (16%), histologically confirmed colonic cancer in 5 (5%), anorectal cancer in 4 (4%), cancer of the caecum in 2 (2%), faecal impaction in 2 (2%) patients, anal wart in 1 (1%), polyps in 1 (1%) and anal fistula 1(1%) patient as shown in Fig. 3.
Les suivants etaient les donnees coloscopiques maqueuse normale dans 24% de patients colite dans 24%, hemorrhoids dans 20%, scissure anale dans 16%, histologiquement cancer du colon confirme dans 5%, cancer anorectal dans 4%, cancer du caecum das 2%, impaction fecale dans 2% verraen du anale dans 1%, polypes dans 1% et fistule anale 1% de patient montres dans la fig. 3
Amoebic colitis was histologically confirmed and accounted for 18 patients with colitis which is 75% of the cases of colitis while ascariasis was responsible for 4 (16%) cases of colitis, and intestinal schistosomiasis was responsible for 2 (8%) cases of colitis as shown in Fig. 4.The diagnostic yield is the ratio between the total number of cases with findings and the total number of colonoscopy done.
Amibe colite etait hiastologiquement confirme et attribue pour 18 patients avec colite qui est 75% des cas de colite don't l'azcaris etait responsable pour 4 (16%) des cas de colite et schistosomiase intestinale, etait responsable pour 2 (8%) des cas de colite montres dans la fig.4
The diagnostic yield in this study was 76 (76%) patients out of 100(100%).
Le rendement du diagnostic est le rapport entre le nombre total des cas des donnees et le nombre total de coloscopies faites. Le rendement du diagnostic dans cette etude etiat 76% de patients sur 100%.
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Discussion There was a consistent increase in the age of th the patients till the 5 decade i.e. 4150years,therafter, there was a decline. Our study has shown an overall diagnostic yield of 76.0% at colonoscopy. This figure is similar to the 79.0% diagnostic yield found by Ismaila et al in Jos, Nigeria7. Studies in Ilorin, Nigeria also showed a 8 similarly high diagnostic yield . This same pattern was also reported in various parts of the West African sub-region by Mbengue et al9 in Senegal and Dakubo et al10 in Ghana. Depending on the sample size, varieties of colonic disease and the different selection criteria and indications, the diagnostic yield may differ. Worldwide, colonoscopy for frank lower gastrointestinal bleeding and positive faecal occult blood test, has an increased yield for cancer. This study showed that the commonest indications for colonoscopy were lower gastrointestinal bleeding, alteration in bowel habit, and the suspicion for colorectal cancer. These were also the indications for colonoscopy in the study carried out by 11 12 13 Berkowitz and Kaplan , Sahu et al and Kassa in their South African, Indian and Ethiopian patients respectively. The commonest pathologies seen at colonoscopy in this study were colitis 24%, hemorrhoids in 20% and anal fissure in 16%. These indications differ significantly from the work done in upland areas and developed countries where cancers of the colon and anorectal regions including diverticulosis were the predominant findings . It is noteworthy that vegetable diets are staple in this environment and contributed to the low incidence of colorectal cancers and 69
Discussion Il a eu angmentation consistente en age des patients jusqui a la se decennie c.a.d 41-50ans pui après il a en un arret. Notre etude a montre un aperu general du rendement du diagnostic trouve par Ismail et al a Jos Nigeria. Les etude en Ilorin, Nigeria aussi ont montre une similarite, elevee du rendement du diagnostic le meme schema etait aussi reporte dans differentes sous region ouest Africaine par Mbeque et la au Senegal et Dakubo et la au Ghana. Basant sur cet echantilon varietes de maladies du colon et differentes selection de criteres et donnees, le rendemnt du diagnostic pent differer (Changer). Universellement, coloscopie pour franc saignement gastro intestinaux et test positive de presence de sang occutte dans les selles a un rendement eleve de cancer. Cette etude a montre que les donnees freqquentes pour la coloscopie etaient saignement gastro intestinaux, alteration habituelle de l'intestin et la soupon pour cancer colorectal. Ceux ci etaient aussi les donnees pour coloscopie dans l'etude effectuee par Berkowitz et Kaplan Sahu et al et Kassa en leurs patients sud Africains, Indiens et Ethopiens respectivement. Les apthologies frequentes vues a la coloscopie dans cette etude etaient colite 24%, hemorrhoids dans 20% et scissure anale dans 16%, ces donnees different netlement du travail fait dans les regions elevees et pays developpes u cancer des region du colon et de l'ano rectal inclue la diverticulose etaient les conclusions predominantes. Le est a noter que le regime de legumes sont des aliments debase dans cet environnement et contribute a la baisse incidence du cancer colorectal et la diverticulose dans cette etude.
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Experience With Colonoscopy In The Riverine Southwestern Nigeria Experience Avec La Coloscopic En Milieux Riverains Sud-quest Du Nigeria
diverticulosis in this study. In nearly all symptomatic patients, heamatophagous trophozoites of E. histolytica were seen in their stool specimens and rectal biopsy specimens. Colonoscopy and biopsy even in patients with colitis is, however safe and 14 affordable.
Dans Presque tous les patients symptomatiques triphozoites hematophages de E. Histolytica etaient vues dans leurs echantillons de selles et boipsie rectale. Coloscopie et biopsie meme sur les patients de colite est pourtant sur et abordable.
Another cause of colitis in this study was heavy infestation with ascaris lumbricoides as a result of consumption of unsafe water and contaminated food. Dead and dying ascaris were visualized during the procedure. In some cases, bolus of dead worms was extracted from the large gut during the procedure and there was a marked hyperaemia of the gut mucosa due to the inflammation associated with the worms.
Autre cause de colite dans cette etude etiat une forte infestation avec l'ascaris lumbriciodes comme resultat de consummation d'eau polleuee et aliments contamines morts et mourants ascaris etaient visualizes pendant la procedure. Dans certains cas, sequella de vers morts etait extrait de gros intestine pendant la procedure et il etait une hypermhemie marquee de la muquense intestinale due a l'inflammatioon associee avec les vers.
In this study, intestinal schistosomiasis (S. mansoni and S. Japonicum ) infestation was associated mainly with mucoid bloody diarrhea and abdominal pains. Anal fissure are characteristically located in the posterior midline at 6 o'clock position. Sahu et al found ulcerative colitis to be the most frequent pathology in Indians but none was observed in this study in keeping with the low incidence of ulcerative colitis in African populations because of high vegetable content in most staple diets in the continent15-17. A case of familial adenomatous polyposis was detected in this study. This was a 30-year old male who had appendicectomy but continued to have lower abdominal pain, waist pain and chronic constipation. The findings at colonoscopy including the result of biopsy were in keeping with familial adenomatous polyposis as shown in Fig. 5. Adenomatous poliposis coli is associated with cell cycle control by regulating the 18-25 intracytoplasmic pool of B-catenin .
Dans cette etude de schistosomiase intestinale (S. mansoni et S. Japonicum) infestation etait associee souvent avec diarrhea saignant et douleur abdominale. Scissure anales sont systematiquement localizes dans la ligne mediane posterieure et vereticalement. Sahu et al trouva la colite ulcereuse etre le plus frequent pathologie chez les indiens mais aucunne'etait observe dans celte etude par rapport ala baisse d'incidence de chez les populations africains a cause deu la ulcereuse proportion elevee de legumes contenus dans les eliments de base dans le continent. Un cas de la polypose adenomateuse familiale etait detecte dans celte etude c'etait un home de 30 ans qui a eu l'appendicectomie mais continuait d'avoir des douleurs en bas de l'abdomen. Maux de reins et constipation chronique les donnees de coloscopie avec resultat de biopsie eta i e nt ave c avo u t d e l a p o l y p o s e adenomateuse familiale comme l'indique Fig.5. Polypose coli adenomateuse est associee avec cycle cellulaire controle par regulation du pool intra-cytoplasmique du B-catenin.
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Experience With Colonoscopy In The Riverine Southwestern Nigeria Experience Avec La Coloscopic En Milieux Riverains Sud-quest Du Nigeria
Colonoscopy has the advantage of providing intervention in the natural history of colorectal cancer by facilitating endoscopic polypectomy. The disadvantages include colonic perforation (1/2000 to 1/2500 examinations) as well as significant bleeding (
EXPERIENCE WITH COLONOSCOPY IN THE RIVERINE SOUTHWESTERN NIGERIA EXPERIENCE AVEC LA COLOSCOPIC EN MILIEUX RIVERAINS SUD-QUEST DU NIGERIA 1
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*OBONNA GC , AROWOLO AO , AGBAKWURU A . Abstract Background: Colonoscopy is useful for diagnosis, treatment and surveillance of anal and colorectal lesions. It affords a good, less invasive and tolerable way to see and access the large intestine. Aim and Objective: To determine the indications, finding and diagnosis at colonoscopy in a riverine setting in Southwestern Nigeria. Type of study: Descriptive cross sectional study. Patients and Methods: Patients who presented in the State Specialist Hospital, Okitipupa and requiring colonoscopy in their management between January 2011 to April 2013 were included in this study. They were reviewed and their demographic and clinical data, indications for colonoscopy, the findings and the pathological diagnosis were entered in a proforma. Results: Colonoscopy was done in 100 patients out of which seventy seven (77%) were males and 23 (23%) were females. The indications were frank lower gastrointestinal bleeding 55 (55%) chronic diarrhea (11%), chronic constipation10(10%), occult gastrointestinal bleeding (7.0%), lower abdominal and anal pain 4 (4.0%), queried anorectal cancer 3 (3.0%) and enterocutaneous fistula 1(1%). Colonoscopic findings, include, normal finding 24(24%) colitis 24 (24.0%), hemorrhoid 20(20.0%), Anal fissure 16 (16.0%) colonic cancer 5 (5.0%), anorectal cancer 4 (4.0%), caecal cancer 2 (2.0%) faecal impaction 2 (2.0%), anal wart 2 (2.0%) , polyps 1 (1.0%) and anal fistula 1 (1.0%). The diagnostic yield was 76%. Conclusion: Bleeding from the lower gastrointestinal tract was the commonest indication for colonoscopy and the most frequent pathology was amoebic in the riverine Southwestern Nigeria. Key words: Colonoscopy, Amoebic colitis, Haematochezia, Southwest Nigeria. Résumé Contexte: La coloscopie est utile pour le diagnostic, traitement surveillance de lesoinsColorectals et anales. Elle procure un bon, moins invasif et tolerable moyen de voir et avoir acces en gros intestin But et objectif: Pour determiner les indications, conclusions et diagnostics a la coloscopie dans les milieux riverains an sud ouest du Nigeria. Type d'etude: Etude transversale descriptive par observation. Patients Et Methodes: Les patients presentes a l'hopital des specialists de l'etat (State Specialist Hospital), a Okitipupa, et demandant la coloscopie dans leur gestion entre Janvier 2011, Avril 2013 etaient inclus dans cette etude. Ils etaient concultees et leur diagramme, demograpgique, clinique, indications pour coloscopie, les conclusions et le diagnostic pathoclogique sont recueillis dans un proformat.
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Resultats: La coloscpie etait faite sur 100 patients don't soixante dix sept pour cent (77%) etaient des homes et vingt trias pour cent (23%) etaient des femmes. Les indications etaient franc interieur saignements gastro intestinaux (55%), diarrhee ehronique, vor (11%), constipation chronique (10%), occulte saignement gastro intestinaux (7.0%), douleurs anales et du bas-ventre (4.0%), cancer anorectal interroge (3.0%) et fistules entero-cutaneas (7%), les conclusions coloscopiques, incluses, donnee normale (24%), colite (24.0%), hemorrhiode (20%), scissure anale (16%), cancer du colon (5.0%) cancer ano-rectale (4%), cancer du caecum (2%), impaction tecale (2.0%), verrue anale (2%), polypes (1.0%) et fistule anale (1%). Le rendement du diagnostic etait de 76% Conclusion: Les saignements de gastro intestinaux de il appareil disgestif etaient de cas de plus revele pour la coloscopie et la plus frequente pathologie etait l'amibe dans les milieux riverains au sud ouest du Nigeria. Mots Cles: Coloscopie colite amibiase, haemetochezia sud ouest Nigeria.
Introduction
Introduction
Treatment of some rectal and colonic pathologies could be effected even during a diagnostic colonoscopy and could be safely carried out on out-patient basis.1,2
le traitment de certaines pathologies rectales et du colon devrait etre effectue meme pendant un diagnostic coloscopique et devrait etre. Soigneusement effectue pique est recommandee la surveillance de detection du cancer colorectal pour ceux a risqué comme une procedure de suivi operationnel dans l'ordre de detecer la recurrence tres tot.
Surveillance colonoscopy is recommended for early detection of colorectal cancer for those at risk and as a post-operative monitoring procedure in order to detect recurrence 2,3 early. Despite the need for colonoscopy in Nigeria, it is still not in common use, so not much work 4, has been reported using this diagnostic tool . This could lead to missed diagnosis with the attendant high morbidity and mortality. . In order to determine the indications and findings in this riverine area, we studied hundred colonoscopies over a two years and four months period at our endoscopy unit. 1
state Specialist Hospital, Okitipupa,ondo State, Nigeria. obafemi Awolowo University Teaching Hospital, Osun State, Nigeria.
2
E-mail: [email protected] *Correspondence Grant support: None Subvention de soutien: Aucune Conflict of Interest: None Conflit d'intérêts: Aucun
Malgre le besoin de la coloscopie au Nigeria, il n'est pas encore en emploi general peu de travaux ontete rappotes utilisant la outils du diagnostic. Ceci pourrait conduire a des echecs diagnostiques avec un taux eleve de morbidite et de mortalite. Dans l'ordre de determiner les donnees et conclusions dans ces milieux riverains nous avons etudie cent coloscopies sur une periode de deux ans et quatre mois dans notre unite d'endoscopie. Materiels et Methodes: Suivant l'information recent tous les patients referes pour la coloscopie a l'hopital des specialistes de l'Etat a Okitipupa, Etat d'Ondo, Nigeria entre Janvier 2011 et Avril 2013 ont forme le cible groupe de cette etude. Leur diagramme demographique et clinique tout comme les donnees closcopiques, traintement et resultat etaient recueillis dans un pro-format.
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Experience With Colonoscopy In The Riverine Southwestern Nigeria Experience Avec La Coloscopic En Milieux Riverains Sud-quest Du Nigeria
Materials and Methods Following informed consent, all the patients referred for colonoscopy at the State Specialist Hospital Okitipupa, Ondo State, Nigeria between January 2011 and April 2013 formed the study group in this study. Their demographic and clinical data as well as the colonoscopic findings, treatment and outcome were recorded in a proforma. All the colonoscopies were done with a Pentax video colonoscope with a light source color temperature: ≥3200k, color rending index :≥85%, illuminance:≥7x 104 Lux with a pump pressure of 40-60 kpa while the flux was ≥5 L / min. Colonoscopy requires a full bowel preparation accompanied by fasting and sedation prior to commencing the procedure. Bowel preparation regimen consisted of ingestion of a total of 40pills of sodium phosphate (visicol), with 5 pills taken every hour with a full glass of water. When the pills are not available we used the liquid sodium phosphate solution (fleet's phospho- soda) 45ml taken twice 8- 12 hours apart. Patient is placed on liquid diet during the period of this mechanical bowel preparation. After establishing an intravenous line, 10mg of diazepam and 30mg of pentazocine were administered to achieve sedation and analgesia respectively. Digital rectal examination is a sine qua non before starting the standard process of colonoscopy. Results Out of a total of 100 patients, 77 (77%) were males while 23 (23%) were females giving a male to female ratio of 3.5:1. Their age ranges from 15 to 86 years. The age distribution is as shown in Fig. 1. The indications for colonoscopy include frank bleeding per rectum in 55 (55%) patients, chronic diarrhea in 11 (11%), chronic constipation in 10 (10%), suspicion of colonic cancer in 9 (9%) patients, tarry black stools in 7 (7%), lower abdominal /anal pain in 4 (4%),suspicion of anorectal cancer in 3(3%) and enterocutaneous fistula in one(1%) patient as shown in Fig. 2. 65
Toutes les coloscopies etaient faites avec PENTAX video coloscope avec une source de lumiere coloree, temperature > 3200k, couleur indice dechirant > 85%, illuminance > 7x104 lux avec une pression de la pompe de 40-60 kpa pendant que le flux etait > 5L/mm. La coloscopie demande une totale preparation de L'intestin accompagnee de jeune et sedation avant de commencer la procedure. Le traitement de la preparation de l'intestin consiste a avaler un total de 40 comprimes de phosphate de sodium (visicol) prise de comprimes par heure avec un verre d'eau. Quand les comprimes sont introuvables nous utilisons la solution de phosphate de sodium liquide ( fleet's phosphate soda) 45ml prise deux fois entre 8 et 12 heure de temps patient plac sous la perfusion pendant la periode de son mecanisme de preparation de l'intestin. A pres une intervention intraveineuse, 10mg de diazepam et 30mg de pentazoane etaient administers pour achiever la sedation et lanalgesie respectivement. Le touches rectal est un “sine quanon” avant de debut proprement diat de a coloscopie. Resultats: Sur un total de 100 patients 77% etaient hommes don't femmes 23% avec donnee un homme pour une femme 1% poue 3-5% (ratio 3:5:1) leur classe d'age est de 15 a 86 ans. La repartition d'age est selon la fig.1 Les donnees poue la coloscopie inclus franc saignement par rectum sur 55% de patients, diarrhea chronique dans 11%, constipation chronique dans 10% soupcon de cancer du colon dans 9%, selles noires dans 7%, douleurs anales et du bas ventre dans 4%, soupzon du cancer ano-rectal dans 3% et fistule entrocutanee dans 1% de patient montres dans la fig.2
JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NO 2, APRIL – JUNE 2012
Experience With Colonoscopy In The Riverine Southwestern Nigeria Experience Avec La Coloscopic En Milieux Riverains Sud-quest Du Nigeria
The following were the colonoscopic findings: normal mucosa in 24(24%) patients, colitis in 24 (24%), hemorrhoids in 20 (20%), anal fissure in 16 (16%), histologically confirmed colonic cancer in 5 (5%), anorectal cancer in 4 (4%), cancer of the caecum in 2 (2%), faecal impaction in 2 (2%) patients, anal wart in 1 (1%), polyps in 1 (1%) and anal fistula 1(1%) patient as shown in Fig. 3.
Les suivants etaient les donnees coloscopiques maqueuse normale dans 24% de patients colite dans 24%, hemorrhoids dans 20%, scissure anale dans 16%, histologiquement cancer du colon confirme dans 5%, cancer anorectal dans 4%, cancer du caecum das 2%, impaction fecale dans 2% verraen du anale dans 1%, polypes dans 1% et fistule anale 1% de patient montres dans la fig. 3
Amoebic colitis was histologically confirmed and accounted for 18 patients with colitis which is 75% of the cases of colitis while ascariasis was responsible for 4 (16%) cases of colitis, and intestinal schistosomiasis was responsible for 2 (8%) cases of colitis as shown in Fig. 4.The diagnostic yield is the ratio between the total number of cases with findings and the total number of colonoscopy done.
Amibe colite etait hiastologiquement confirme et attribue pour 18 patients avec colite qui est 75% des cas de colite don't l'azcaris etait responsable pour 4 (16%) des cas de colite et schistosomiase intestinale, etait responsable pour 2 (8%) des cas de colite montres dans la fig.4
The diagnostic yield in this study was 76 (76%) patients out of 100(100%).
Le rendement du diagnostic est le rapport entre le nombre total des cas des donnees et le nombre total de coloscopies faites. Le rendement du diagnostic dans cette etude etiat 76% de patients sur 100%.
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Discussion There was a consistent increase in the age of th the patients till the 5 decade i.e. 4150years,therafter, there was a decline. Our study has shown an overall diagnostic yield of 76.0% at colonoscopy. This figure is similar to the 79.0% diagnostic yield found by Ismaila et al in Jos, Nigeria7. Studies in Ilorin, Nigeria also showed a 8 similarly high diagnostic yield . This same pattern was also reported in various parts of the West African sub-region by Mbengue et al9 in Senegal and Dakubo et al10 in Ghana. Depending on the sample size, varieties of colonic disease and the different selection criteria and indications, the diagnostic yield may differ. Worldwide, colonoscopy for frank lower gastrointestinal bleeding and positive faecal occult blood test, has an increased yield for cancer. This study showed that the commonest indications for colonoscopy were lower gastrointestinal bleeding, alteration in bowel habit, and the suspicion for colorectal cancer. These were also the indications for colonoscopy in the study carried out by 11 12 13 Berkowitz and Kaplan , Sahu et al and Kassa in their South African, Indian and Ethiopian patients respectively. The commonest pathologies seen at colonoscopy in this study were colitis 24%, hemorrhoids in 20% and anal fissure in 16%. These indications differ significantly from the work done in upland areas and developed countries where cancers of the colon and anorectal regions including diverticulosis were the predominant findings . It is noteworthy that vegetable diets are staple in this environment and contributed to the low incidence of colorectal cancers and 69
Discussion Il a eu angmentation consistente en age des patients jusqui a la se decennie c.a.d 41-50ans pui après il a en un arret. Notre etude a montre un aperu general du rendement du diagnostic trouve par Ismail et al a Jos Nigeria. Les etude en Ilorin, Nigeria aussi ont montre une similarite, elevee du rendement du diagnostic le meme schema etait aussi reporte dans differentes sous region ouest Africaine par Mbeque et la au Senegal et Dakubo et la au Ghana. Basant sur cet echantilon varietes de maladies du colon et differentes selection de criteres et donnees, le rendemnt du diagnostic pent differer (Changer). Universellement, coloscopie pour franc saignement gastro intestinaux et test positive de presence de sang occutte dans les selles a un rendement eleve de cancer. Cette etude a montre que les donnees freqquentes pour la coloscopie etaient saignement gastro intestinaux, alteration habituelle de l'intestin et la soupon pour cancer colorectal. Ceux ci etaient aussi les donnees pour coloscopie dans l'etude effectuee par Berkowitz et Kaplan Sahu et al et Kassa en leurs patients sud Africains, Indiens et Ethopiens respectivement. Les apthologies frequentes vues a la coloscopie dans cette etude etaient colite 24%, hemorrhoids dans 20% et scissure anale dans 16%, ces donnees different netlement du travail fait dans les regions elevees et pays developpes u cancer des region du colon et de l'ano rectal inclue la diverticulose etaient les conclusions predominantes. Le est a noter que le regime de legumes sont des aliments debase dans cet environnement et contribute a la baisse incidence du cancer colorectal et la diverticulose dans cette etude.
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diverticulosis in this study. In nearly all symptomatic patients, heamatophagous trophozoites of E. histolytica were seen in their stool specimens and rectal biopsy specimens. Colonoscopy and biopsy even in patients with colitis is, however safe and 14 affordable.
Dans Presque tous les patients symptomatiques triphozoites hematophages de E. Histolytica etaient vues dans leurs echantillons de selles et boipsie rectale. Coloscopie et biopsie meme sur les patients de colite est pourtant sur et abordable.
Another cause of colitis in this study was heavy infestation with ascaris lumbricoides as a result of consumption of unsafe water and contaminated food. Dead and dying ascaris were visualized during the procedure. In some cases, bolus of dead worms was extracted from the large gut during the procedure and there was a marked hyperaemia of the gut mucosa due to the inflammation associated with the worms.
Autre cause de colite dans cette etude etiat une forte infestation avec l'ascaris lumbriciodes comme resultat de consummation d'eau polleuee et aliments contamines morts et mourants ascaris etaient visualizes pendant la procedure. Dans certains cas, sequella de vers morts etait extrait de gros intestine pendant la procedure et il etait une hypermhemie marquee de la muquense intestinale due a l'inflammatioon associee avec les vers.
In this study, intestinal schistosomiasis (S. mansoni and S. Japonicum ) infestation was associated mainly with mucoid bloody diarrhea and abdominal pains. Anal fissure are characteristically located in the posterior midline at 6 o'clock position. Sahu et al found ulcerative colitis to be the most frequent pathology in Indians but none was observed in this study in keeping with the low incidence of ulcerative colitis in African populations because of high vegetable content in most staple diets in the continent15-17. A case of familial adenomatous polyposis was detected in this study. This was a 30-year old male who had appendicectomy but continued to have lower abdominal pain, waist pain and chronic constipation. The findings at colonoscopy including the result of biopsy were in keeping with familial adenomatous polyposis as shown in Fig. 5. Adenomatous poliposis coli is associated with cell cycle control by regulating the 18-25 intracytoplasmic pool of B-catenin .
Dans cette etude de schistosomiase intestinale (S. mansoni et S. Japonicum) infestation etait associee souvent avec diarrhea saignant et douleur abdominale. Scissure anales sont systematiquement localizes dans la ligne mediane posterieure et vereticalement. Sahu et al trouva la colite ulcereuse etre le plus frequent pathologie chez les indiens mais aucunne'etait observe dans celte etude par rapport ala baisse d'incidence de chez les populations africains a cause deu la ulcereuse proportion elevee de legumes contenus dans les eliments de base dans le continent. Un cas de la polypose adenomateuse familiale etait detecte dans celte etude c'etait un home de 30 ans qui a eu l'appendicectomie mais continuait d'avoir des douleurs en bas de l'abdomen. Maux de reins et constipation chronique les donnees de coloscopie avec resultat de biopsie eta i e nt ave c avo u t d e l a p o l y p o s e adenomateuse familiale comme l'indique Fig.5. Polypose coli adenomateuse est associee avec cycle cellulaire controle par regulation du pool intra-cytoplasmique du B-catenin.
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Colonoscopy has the advantage of providing intervention in the natural history of colorectal cancer by facilitating endoscopic polypectomy. The disadvantages include colonic perforation (1/2000 to 1/2500 examinations) as well as significant bleeding (
