Familial Adenomatous Polyposis, El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
Familial Adenomatous Polyposis of the colon. A colonoscopy performed in retroflexed maneuver from the cecum to the rectum. We have found nobody in the medical literature ever performed a complete colonoscopy in retroflexed maneuver from the cecum to the rectum in this fashion. Therefore we are claiming this achievement as a record. The image above reveals an enormous tubular and stalked polyp at the hepatic angle.

Video Endoscopic Sequence 1 of 27.

Familial Adenomatous Polyposis of the colon.

 A colonoscopy performed in retroflexed maneuver from
 the cecum to the rectum.
 We have found nobody in the medical literature ever
 performed a complete colonoscopy in retroflexed maneuver
 from the cecum to the rectum in this fashion.
 Therefore we are claiming this achievement as a
 record.
 The image above reveals an enormous tubular and stalked
 polyp at the hepatic angle.
 

 A Case of Familial polyposis of the colon with two
 adenocarcinomas are in colonic carcinoma chapter

 Click on the endoscopic images to download the video
 clips.
 All endoscopic images shown in this Atlas contains video
 clips.  
Our patient is a 27 year-old man from the republic of Nicaragua. His father died of colon carcinoma at the age of 36. Two brothers had colectomies due to similar familial polyposis. His sister did not manifest this disease. The patient underwent a colectomy. The image of the sigmoid show a stalked polyp where multiple smaller polyps are seen nearby.

Video Endoscopic Sequence 2 of 27.

 Our patient is a 27 year-old man from the republic of
 Nicaragua. His father died of colon carcinoma at the age
 of 36. Two brothers had colectomies due to similar familial
 polyposis. His sister did not have the disease.

 The patient underwent a colectomy. The image of the
 sigmoid show a stalked polyp where  multiple smaller
 polyps are seen nearby.

                                         Medline.

Retroflexed view of the enormous stalk of the biggest tumor at hepatic angle. There are several tiny polyps. Findings are indicative of Familial Adenomatous Polyposis (APC), an autosomic dominantly inherited disease characterized by the presence of 100 or more colorectal adenomatous polyps. The development of colon carcinoma is unavoidable if left untreated. This disease is inherited as an autosomal dominant disorder with a 80% to 100% penetrance. Adenocarcinoma is the inevitable consequence of APC unless the colon is removed. Multiple colon malignancies can occur. Colon Cancer has been reported as early as 9 years of age, although the occurrence of malignancy before adolescence is unusual.

Video Endoscopic Sequence 3 of 27.

 Retroflexed view of the enormous stalk of the biggest
 tumor at hepatic angle. There are several tiny polyps.
 Findings are indicative of Familial Adenomatous Polyposis
 (APC), an autosomic dominantly inherited disease
 characterized by the presence of 100 or more colorectal
 adenomatous polyps. The development of colon carcinoma
 is unavoidable if left untreated.
 This disease is inherited as an autosomal dominant
 disorder with a 80% to 100% penetrance.
 Adenocarcinoma is the inevitable consequence of APC
 unless the colon is removed. Multiple colon malignancies
 can occur.
 Colon Cancer has been reported as early as 9 years of
 age, although the occurrence of malignancy before
 adolescence is unusual.    
The cecum. The right colon is affected only with some tiny polyps.

Video Endoscopic Sequence 4 of 27.

The cecum.

 The right colon is affected only with some tiny polyps.

 

The ileocecal valve. Tiny polyps are observed. The video clip displays the beginning of ther retroflexed maneuver.

Video Endoscopic Sequence 5 of 27.

The ileocecal valve.

 Tiny polyps are observed.
 The video clip displays the beginning of ther retroflexed
 maneuver. 
Ascending Colon:. The beginning of a special way to explore the colon by viewing it from cecum to rectum in retroflexed maneuver We have not come across any prior experience with a total retroflexed colonoscopy in the world´s literature. We recommend that you look at the complete video sequence to appreciate the advantages of this retroflexed procedure.

Video Endoscopic Sequence 6 of 27.

 Ascending Colon:
 The beginning of a special way to explore the colon by
 viewing it from cecum to rectum in retroflexed maneuver
 We have not come across any prior experience with a total
 retroflexed colonoscopy in the world´s literature.
 We recommend that you look at the complete video
 sequence to appreciate the advantages of this retroflexed
 procedure.
 
Retroflexed view of ascending colon near the hepatic angle.

Video Endoscopic Sequence 7 of 27.

 Retroflexed view of ascending colon near the hepatic angle.
   
 
Retroflexed view of hepatic angle, the biggest polypoid tumor of the series is starting to appear.

Video Endoscopic Sequence 8 of 27.

 Retroflexed view of hepatic angle, the biggest polypoid
 tumor of the series is starting to appear.  

Retroflexed view of hepatic angle. The largest tumor of this case is seen.

Video Endoscopic Sequence 9 of 27.

 Retroflexed view of hepatic angle.
 The largest tumor of this case is seen.

Retroflexed view of the same case at the hepatic angle. The view of this colonoscopy is different from a regular colonoscopy. The image displays an enormous pedicle of the biggest polyp. Some tiny polyps are observed nearby.

Video Endoscopic Sequence 10 of 27.

 Retroflexed view of the same case at the hepatic angle.
 The view of this colonoscopy is different from a regular
 colonoscopy.
 The image displays an enormous pedicle of the biggest
 polyp.
 Some tiny polyps are observed nearby.
 
Retroflexed view of the hepatic flexure.A large twisted stalk and the polyps are seen.

Video Endoscopic Sequence 11 of 27.

 Retroflexed view of the hepatic flexure.
 A large twisted stalk and the polyps are seen.

 
After overcoming some difficulties at the hepatic angle we came to the transverse colon.

Video Endoscopic Sequence 12 of 27.

 After overcoming some difficulties at the hepatic angle
 we came to the transverse colon.

 
The transverse colon is seen in retroflexed view. The video clip displays the long trajectory across the transverse colon.

Video Endoscopic Sequence 13 of 27.

 The transverse colon is seen in retroflexed view.

 
 
 The video clip displays the long trajectory across the
 transverse colon.
The transverse colon in retroflexed maneuver.

Video Endoscopic Sequence 14 of 27.

 The transverse colon in retroflexed maneuver.

 
Splenic flexure in retroflexed view. There are several tiny polyps. The entire colon looks somewhat different in retroflexed view. Observe this angle view that is different of normal forward view

Video Endoscopic Sequence 15 of 27.

 Splenic flexure in retroflexed view.
 There are several tiny polyps.
 The entire colon looks somewhat different in retroflexed
 view. Observe this angle view that is different of normal
 forward view.
Splenic angle is seen in a different view from a conventional colonoscopy.

Video Endoscopic Sequence 16 of 27.

 Splenic angle is seen in a different view from a
 conventional colonoscopy.
 
Descending colon in retroflexed view is seen. There are several and some pediculated adenomas.

Video Endoscopic Sequence 17 of 27.

 Descending colon in retroflexed view is seen.
 There are several and some pediculated adenomas.
   
 Download the video clip.
Adenomas of different sizes, stalked and sessile.

Video Endoscopic Sequence 18 of 27.

 Adenomas of different sizes, stalked and sessile.




 
Descending-Sigmoid junction. Several tiny polyps are appreciated.

Video Endoscopic Sequence 19 of 27.

 Descending-Sigmoid junction.
 Several tiny polyps are appreciated.
 
Rectum seen in retroflexed maneuver. Finally, we got to the end. A complete colonoscopy in retroflexed maneuver from the cecum to the rectum. The colonoscopy in retroflexed maneuver offers additional views of the colon which increases the sensitivity of the procedure in some cases. The retroflex maneuver, which is commonly utilized within the stomach and esophagus, where it is of great benefit to detect small lesions, had not been utilized within the colon either because it was deemed unnecessary, because of its technical difficulty or because of the fear of perforation. We believe that, as part of the development and evolution of endoscopic technique, the complete retroflexed colonoscopy maneuver has its place as a special endoscopic procedure in selected cases.

Video Endoscopic Sequence 20 of 27.

 Rectum seen in retroflexed maneuver.

 Finally, we got to the end. A complete colonoscopy in
 retroflexed maneuver from the cecum to the rectum.
 The colonoscopy in retroflexed maneuver offers additional
 views of the colon which increases the sensitivity of the
 procedure in some cases. The retroflex maneuver, which
 is commonly utilized within the stomach and esophagus,
 where it is of great benefit to detect small lesions, had not
 been utilized within the colon either because it was
 deemed unnecessary, because of its technical difficulty or
 because of the fear of perforation. We believe that, as part
 of the development and evolution of endoscopic technique,
 the complete retroflexed colonoscopy maneuver has its
 place as a special endoscopic procedure in selected cases. 
 
Post surgical status, patient underwent surgery. The image and the video display the scar of the Ileorectal Anastomosis. Ablation of rectal adenomas every 6 to 12 months should be done.

Video Endoscopic Sequence 21 of 27.

 Post surgical status, patient underwent surgery.
 The image and the video display the scar of the Ileorectal
 Anastomosis .
 Ablation of rectal adenomas every 6 to 12 months should
 be done.
Terminal ileum. The image and the video terminal ileum is observed which has been jointed with the rectum, hyperplasia linfoide is observed which is normal in the terminal ileum.

Video Endoscopic Sequence 22 of 27.

Terminal ileum.

 The image and the video terminal ileum is observed
 which has been jointed with the rectum, hyperplasia
 linfoide is observed which is normal in the terminal ileum.
 
Papilla of Vater. A small adenoma is observedin the same patient above. A carefully inspection of the papilla of Vater should be done removing any adenoma to avoid adenocarcinoma of the duodenum and the papilla of Vater, occurs in as many as 12% of patients. Patients with familial adenomatous polyposis (FAP) have a high prevalence of duodenal adenomas, and the region of the ampulla of Vater is the predilection site for duodenal adenocarcinomas. The average age at diagnosis of periampullary cancer in patients with polyposis is 46 years, compared with 39 years for the age of colon cancer diagnosis. fifty percent of patients with polyposis exhibit adenomatous histology of the papilla, although the polyps are often small and difficult to appreciate without a side- viewing endoscope.

Video Endoscopic Sequence 23 of 27.

Papilla of Vater.

 A small adenoma is observedin the same patient above.
 A carefully inspection of the papilla of Vater should be
 done removing any adenoma to avoid adenocarcinoma of
 the duodenum and the papilla of Vater, occurs in as many
 as 12% of patients.
 Patients with familial adenomatous polyposis (FAP) have a
 high prevalence of duodenal adenomas, and the region of
 the ampulla of Vater is the predilection site for duodenal
 adenocarcinomas.
 The average age at diagnosis of periampullary cancer in
 patients with polyposis is 46 years, compared with 39
 years for the age of colon cancer diagnosis.
 fifty percent of patients with polyposis exhibit
 adenomatous histology of the papilla, although the polyps
 are often small and difficult to appreciate without a side-
 viewing endoscope.
 More than one third of the duodenal cancers reported
 occur at the papilla, and obstruction of the pancreatic duct
 has been observed from benign and malignant neoplasia
 of the papilla.

                                          Medline.  
Minor papilla. The video clip displays both papillas.

Video Endoscopic Sequence 24 of 27.

Minor papilla.

The video clip displays both papillas.

 
Argon Plasma Coagulator. APC has a useful application in the fulguration of small rectal polyps in FAP. .

Video Endoscopic Sequence 25 of 27.

Argon Plasma Coagulator.

 APC has a useful application in the fulguration of small
 rectal polyps in FAP.
 
 
Status post argon plasma coagulator APC.

Video Endoscopic Sequence 26 of 27.

 Status post argon plasma coagulator APC.

 More endoscopic details download the video clip by
 clicking on the endoscopic image.
Two weeks after the Argon Plasma Coagulator, The image and the video display several rectal ulcers some of them with visible vessels.

Video Endoscopic Sequence 27 of 27.

 Two weeks after the Argon Plasma Coagulator. 
 The image and the video display several rectal ulcers
 some of them with visible vessels.