DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Evaluation for iron-deficiency anemia.
POSTOPERATIVE DIAGNOSES:
1. Internal hemorrhoids.
2. Sigmoid diverticulosis.
3. Colonic arteriovenous malformation.
PROCEDURE PERFORMED: Colonoscopy and terminal ileum cannulation with argon plasma coagulation cauterization.
PERFORMING PHYSICIAN: John Doe, MD
ANESTHESIA: See EGD report dictated same day.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: Informed written consent was obtained after explaining the risks of bleeding, infection, allergy, and perforation requiring medical or surgical management. Parenteral anesthesia was administered with continuous monitoring of oxygen saturation and vital signs. The perianal and digital rectal examination revealed hemorrhoids. Colonoscope through the anus was advanced to the cecum. The terminal ileum was normal. The ileocecal valve and cecum demonstrated two cecal arteriovenous malformations, which were cauterized with the APC at 40 watts of flow at 1.4 liters second complete ablation. The ascending colon, transverse, descending, sigmoid colon demonstrated sigmoid diverticulosis as well as three sigmoid arteriovenous malformations, which were cauterized with the APC with complete hemostasis. During the procedure, as we were pulling the scope out across transverse colon, the patient became slightly hypotensive. We put the patient in the Trendelenburg positioning. Blood pressure still ranged in the 65-75 systolic range. Therefore, we gave her Narcan to assist in correction of her mild hypotension. She responded appropriately. Immediate blood pressure was 90 systolic. Inspection of the sigmoid colon and rectum demonstrated, otherwise, the aforementioned internal hemorrhoids on retroflexed view. Endoscope was withdrawn. The patient was taken to the recovery room in stable condition.
IMPRESSION AND PLAN: Diagnostic colonoscopy demonstrated vascular malformations causing iron-deficiency anemia. The patient will continue iron b.i.d. Recheck CBC in four weeks. See esophagogastroduodenoscopy dictated same day concerning further evaluation. Further recommendations to see how she does after correction of blood counts with iron as well as status post cauterization of multiple gastrointestinal vascular malformations.
