Early flexible sigmoidoscopy in the evaluation of acute left iliac fossa pain

To evaluate the feasibility, safety and diagnostic yield of flexible sigmoidoscopy as an early diagnostic tool in the investigation of the colonic causes of acute left iliac fossa pain.

A 1-year prospective study was conducted in which flexible sigmoidoscopy was performed as soon as possible by two consultant coloproctologists within their normal theatre sessions on all emergency patients admitted with acute left iliac fossa pain. The clinical details, flexible sigmoidoscopy findings and subsequent outcome were recorded on a proforma.

It was possible to perform early flexible sigmoidoscopy on 86% (62/72) of patients referred during their in-patient stay at a median delay of 4 days from time of admission. Eighty-four percent of the examinations resulted in a diagnosis or exclusion of a colonic cause for their acute left iliac fossa pain. There was low morbidity and one unrelated death in the study.

This study has shown that it is feasible to use early flexible sigmoidoscopy as a first line investigation for patients presenting with acute left iliac fossa pain. Flexible sigmoidoscopy is a quick and safe procedure in skilled hands with a high diagnostic yield, although the potential risks involved in performing this procedure in the acute period mandate that it should only be undertaken by experts.