Colon Miscellaneous Atlas of Gastrointestinal Video Endoscopy
Ileocecal valve incompetence

Video Endoscopic Sequence 1 of 2.

Ileocecal valve incompetence

Ileocecal valve is fully open and easy to advance the colonoscope through the terminal ileum.

 

For more endoscopic details download the video clips by
clicking on the endoscopic images, wait to be downloaded
complete then press Alt and Enter that you can appreciate
the video in full screen.

All endoscopic images shown in this Atlas contain
video clips.

 

 

Ileocecal valve incompetence

Video Endoscopic Sequence 2 of 2.

Ileocecal valve incompetence

 

Relatamos el caso de una paciente de 66 años con cirrosis,

Video Endoscopic Sequence 1 of 4.

Psoriasis Colitis and or Chickenpox (Varicella)

Colonoscopy some nonspecific ulcers are observed.

Correlations between Psoriasis and Inflammatory Bowel Diseases.

We report the case of a 44 year-old female, who suffers from psoriasis, was hospitalized due to adynamic ileus, abdominal distension had frank, absent bowel sounds in plain abdominal X-ray displayed, dilated bowel loops.

Due to their underlying disease is administered intravenous corticosteroids improving the adynamic ileus, the next day the patient starts with chickenpox.

Complete colonoscopy is practiced finding several ulcers which are shown here.

Paralytic ileus typically presents with abdominal distention and minimal pain, which intensifies with increasing distention. Bowel sounds are generally minimal or absent

For a long time the relationship between inflammatory bowel diseases (IBDs) and psoriasis has been investigated by epidemiological studies.

Numerous reports have demonstrated the epidemiological, pathogenic, and genetic association between psoriasis and Crohn's disease. Nevertheless, the association between psoriasis and ulcerative colitis was rarely described.

 

 

Colonoscopia de Várices Rectales

Video Endoscopic Sequence 2 of 4.

Psoriasis Colitis and or Chickenpox (Varicella)

 

Las várices rectales sangrantes son raras y cuando

Video Endoscopic Sequence 3 of 4.

Psoriasis Colitis and or Chickenpox (Varicella)

 

Video Endoscopic Sequence 4 of 4.

Psoriasis Colitis and or Chickenpox (Varicella)

 

colonoscopio que se trasluce

Video Endoscopic Sequence 1 of 2.

Colonoscopy of colonoscope that been trasluce

 

A black colored image corresponding to the colonoscope tube which is adjacent to the other loop at the splenic flexure.

 

 

 

 

colonoscopio que se trasluce

Video Endoscopic Sequence 1 of 2.

Image colonoscopy image that the colonoscope trasluce through another loop

 

 

Gastrointestinal Stromal Tumour of the Rectum.

Video Endoscopic Sequence 1 of 5.

Gastrointestinal Stromal Tumour of the Rectum.

This 65 year-old female, without a significant medical history presented with rectal bleeding, with the digital examination a hard mass was palpable at 8 cm of the anal verge.

Analysis showed it was a rectal GIST, a rare mesenchymal tumor of the gastrointestinal tract, which expressed CD117 (or c-kit, a marker of kit-receptor tyrosine kinase) and CD34.

Gastrointestinal Stromal Tumour of the Rectum.

Video Endoscopic Sequence 2 of 5.

Endoscopic Image of Gastrointestinal Stromal Tumour of the Rectum.

Gastrointestinal stromal tumors (GIST) were described in 1983 as tumors in the gastrointestinal tract and mesentery, characterized by a specific histological and immunohistochemical pattern.

These tumors occurs at a median age of 60 years in most series, with a slight male predominance. Subsequently, GIST have been shown to exhibit typical activating mutations of the KIT or PDGFRA protooncogenes, which are the likely causal molecular events of GIST.

GIST have a high risk of metastatic relapse, specifically in the liver and peritoneum, after initial surgery for localized disease.

Gastrointestinal stromal tumour (GIST)

Video Endoscopic Sequence 3 of 5.

Gastrointestinal stromal tumour (GIST) has been immunohistochemically defined as the tumour lacking differentiation towards either leiomyomatous tumour or schwannoma.

In general, GISTs are rare mesenchymal tumors of the gastrointestinal tract (nerve tissue, smooth muscle).
Histology and immunohistochemistry discriminate gastrointestinal stromal tumors from leiomyomas and neurinomas.

The most important location is the stomach; the rectal location is rare. Usually, the classic signs of malignancy such as cellular invasion and metastasis are missing.

A set of histologic criteria stratifies GIST for risk of malignant behavior such as mitotic activity and tumor size, cellular pleomorphism, developmental stage of the cell and quantity of cytoplasma. Tumors with a high mitotic activity and size above 5 cm are considered malignant.

Recent pharmacological advances such as tyrosine kinase inhibitors have determined c-kit (i.e., CD117) as the most important marker, amongst others. C-kit positive tumors respond extremely well to chemotherapy with Imatinib (Glivec®, Gleevec®).

Nakayama T, Hirose H, Isobe K, Shiraishi K, Nishiumi T, Mori S, Furuta Y, Kasahara M (2003) Gastrointestinal tumor of the rectal mesentery. J Gastroenterol 38(2):186–189 [PubMed].

 

 

 

Gastrointestinal stromal tumour (GIST)

Video Endoscopic Sequence 4 of 5.

Immunohistochemistry was positive for and CD 117 (c-kit) in the GIST.

A GIST can’t be Diagnosed by H&E

Gastrointestinal stromal tumor (GIST) is a mesenchymal spindle cell (70-80%) or epithelioid (20-30%) neoplasm.
The diagnosis is based on a positive C-kit (CD117) stain, which is a tyrosine kinase growth factor receptor. Some of these tumors also respond dramatically to STI571 (Gleevec). "GIST" is relatively new terminology; these would once have been called leiomyomas, leiomyoblastomas, and/or leiomyosarcomas.

 

 

 

Gastrointestinal stromal tumour (GIST)

Video Endoscopic Sequence 5 of 5.

GISTs occur most often in the stomach (60-70%), followed by the small bowel (20-30%; ileum > jejunum > duodenum), the colon/rectum (5%), and the esophagus (5%).

The majority are benign; 10-30% are malignant. The differentiation is made according to the number of mitoses counted during histological examination. Several factors increase the likelihood of malignancy in GIST.

These include extragastric. location, size greater than 5 cm, central necrosis, extension into adjacent organs, and metastases (occurring in the liver and peritoneum much more frequently than in the lung, bone, or lymph nodes).

Perforation of the sigmoid colon after polypectomy five days before, which was resolved with hemoclips

Video Endoscopic Sequence 1 of 6.

Perforation of the sigmoid colon after polypectomy five days before, which was resolved with hemoclips.

72 year old female patient , who had done a sigmoid polyp polypectomy five days before at another clinic.

The day after the procedure the patient had presented, fever, and on the fourth day she had abdominal pain of high intensity.

She got there the fifth day to ask for a second opinion about the persistent abdominal pain.

The abdomen was soft and depressible with no signs of rebound, but a chest x-ray indicated the presence of air on the sub - diaphragmatic left side.

Immediately , without any preparation of the colon (no laxative) we performed a colonoscopy finding the site of the polypectomy with a small hole and we started to close this hole with hemoclips.

The perforation was completely closed with hemoclips, and the patient was managed with systemic antibiotics. The evolution was excellent avoiding surgery.

The chest x-ray finding left Subdiaphragmatic free gas

Subdiaphragmatic free gas is well appreciated as the air under the diaphragm and air in the lungs outline the diaphragmatic contour well.

As little as 1 ml of free air can be detected but the patient may be needed to be kept in upright position for about 10 minutes for the air to rise.

Erect chest x-rays covering the upper abdomen are often considered the best for detecting free subdiaphragmatic gas but an erect abdominal x-ray covering the lung bases will be just as sensitive.

 

 
Perforation of the sigmoid colon after polypectomy five days before, which was resolved with hemoclips

Video Endoscopic Sequence 2 of 6.

Colon perforation is one of the most dreaded complications of colonoscopy. Traditionally, patients with a colon perforation have been treated surgically. Although there are several case reports documenting the usefulness of endoscopic closure of colon perforations, there are few current data evaluating the feasibility of endoscopic closure for an iatrogenic perforation on consecutive patients undergoing colonoscopy.

Symptoms of intestinal perforation, or more precisely, symptoms of infection include fever, nausea and severe abdominal pain that worsens with movement.

 

Perforation of the sigmoid colon after polypectomy five days before, which was resolved with hemoclips.

Video Endoscopic Sequence 3 of 6.

Application of hemoclips

Clips can be used to close gastrointestinal perforations that may have been caused by complicated therapeutic endoscopy procedures, such as polypectomy, or by the endoscopic procedure itself.

Perforation is an uncommon but potentially devastating complication of colonoscopy. Surgical closure is the standard of care. Immediate endoluminal closure of a perforation would avoid the morbidity and mortality associated with general anesthesia, laparotomy, and surgical repair.

Note: When we were using these hemoclips had no large size, these were small so it was us something hard to close this hole, most manufacturers sell these products for hemostasis, currently there are already some big enough, if we had used I think this one would have been enough to close this hole.

 

Perforation of the sigmoid colon after polypectomy five days before, which was resolved with hemoclips

Video Endoscopic Sequence 4 of 6.

Another image of placement of hemoclips, due to a colon perforation after 5 days post-polypectomy.

Endoscopic closure of small iatrogenic colon perforations with clips results in mucosal and submucosal healing and prevents fecal soiling of peritoneal cavity.

Surgical closure of a colon perforation is accompanied by the risks of general anesthesia and prolonged recovery from surgery because of ileus and other sequelae. Very little is known about the effectiveness of endoluminal repair of colon perforations with clips, which eliminates incisions of the abdominal wall and provides a less invasive alternative to surgical closure.

 

Perforation of the sigmoid colon after polypectomy five days before, which was resolved with hemoclips

Video Endoscopic Sequence 5 of 6.

Endoscopic closure of colonic perforation

The small diameter of the hole Is displayed

Application of these endoscopic closure techniques could help physicians attempt endoscopic resection of large polyps or flat lesions that are otherwise sent to surgery for fear of perforation.

Perforation of the sigmoid colon after polypectomy five days before, which was resolved with hemoclips

Video Endoscopic Sequence 6 of 6.

Successful endoscopic closure of colon perforation. This required multiple hemoclips

Patient, received intravenous antibiotics and were carefully monitored for signs of sepsis.
The patient progressed in excellent condition, disappearing subdiaphragmatic air and was discharged after three days.

Leiomyoma in the Ascending Colon.

Leiomyoma in the Ascending Colon.

A 38 year-old woman, she had rectal bleeding for more than four months.

Colonic leiomyoma is a rare condition. Smooth muscle tumours arising from the colon constitute only 3% of gastrointestinal leiomyomas.

Rectal Dieulafoy’s lesion.

Video Endoscopic Sequence 1 of 4.

Rectal Dieulafoy’s lesion.

A 62 year-old female who presented with massive hematochezia and who was discovered to have a Dieulafoy’s lesion within the rectum. was successfully treated with Argon Plasma Coagulator APC.

Dieulafoy’s lesions located outside of the stomach are rare occurrences. Lesions found within the colon typically present with painless, massive hematochezia.

Colonic Dieulafoy’s lesions are rare but should always be considered in the differential diagnosis of massive hematochezia, because endoscopic therapy appears to result in complete cessation of bleeding.

 

 

Rectal Dieulafoy’s lesion.

Video Endoscopic Sequence 2 of 4.

Coagulation with Argon Plasma.

The image as well as the video clip show retroflexed image.

Urgent colonoscopy has emerged as the initial diagnostic and main therapeutic tool in the evaluation and treatment of colonic lower gastrointestinal bleeding.

Endoscopic therapy can effectively treat most cases of colonic bleeding with a demonstrable improvement in clinical outcome parameters.

Coagulation with Argon Plasma.

Video Endoscopic Sequence 3 of 4.

The identification of high-risk stigmata of hemorrhage enables selective targeting of endoscopic therapy to lesions at high risk of rebleeding.

Advances in technologies such as novel mechanical methods of hemostasis (eg, metallic clips), injection techniques (eg, cyanoacrylate injection), and the widening application of established endoscopic hemostatic techniques (eg, rubber-band ligation) to colonic lesions offers the possibility of further improvements in the efficacy of endoscopic hemostasis.

Coagulation with Argon Plasma.

Video Endoscopic Sequence 4 of 4.

More images and video clips of this case.

Yellowish Colonic Mucosa

Video Endoscopic Sequence 1 of 2.

Yellowish Colonic Mucosa.

This is a 65 year old man with advanced rectal cancer, 18 months previously underwent surgery, now presented with multiple liver metastases and obstructive jaundice.

Yellowish Colonic Mucosa.

Video Endoscopic Sequence 2 of 2.

 Yellowish Colonic Mucosa.

 This video clip shows the passage of feces through the  descendent colon towards the rectum.

Recto-vaginal fistula.

Video Endoscopic Sequence 1 of 3.

Recto-vaginal fistula.

Patient has Cervical Cancer, developed a rectovaginal fistula.

The most common etiology is obstetric injury, followed by radiation injury, inflammatory bowel disease ([IBD], most often Crohn disease), operative trauma, infectious etiologies, and neoplasm.

Recto-Vaginal fistula due to cervix carcinoma.

Video Endoscopic Sequence 2 of 3.

Recto-Vaginal fistula due to cervix carcinoma.
Patient has colostomy in asa.

Radiation used in the treatment of pelvic malignancies may result in RVF. Fistulas that occur during therapy are usually due to tumor regression.

Most other fistulas become apparent 6 months to 2 years after completion of therapy. Diabetes, hypertension, smoking, and previous abdominal or pelvic surgery increase the risk of fistula formation.

Differentiating radiation change at the fistula from a recurrent tumor by biopsy is imperative because neoplasms (primary, recurrent, metastatic) can produce RVFs.

Recto-Vaginal fistula due to cervix carcinoma.

Video Endoscopic Sequence 3 of 3.

The image and the video display a colonoscopy being performed from the rectum and through the colostomy.

For more details download the video clip.

A tablet of medicine found it in the colon.

Video Endoscopic Sequence 1 of 2.

A tablet of medicine found it in the colon.

A not yet dissolved tablet was found in the descending colon.

A tablet of medicine found it in the colon.

Video Endoscopic Sequence 2 of 2.

Another view of this tablet.

Melena seen in Colonoscopy.

Melena seen in Colonoscopy.

A 74 year-old female, was hospitalized due to an upper gastrointestinal hemorrhage, the colonoscopy displayed melena found a the cecum.

Guavas Seeds Incrusted in the Sigmoid

Video Endoscopic Sequence 1 of 3.

Guavas Seeds Incrusted in the Sigmoid

Bilobulated lesion that resemble an ulcerated polyp.
The yellowish color resembles fibrin. two guavas seeds were found to be the cause of the lesion , as they were incrusted in the sigmoid tissue.

Guavas Seeds Incrusted in the Sigmoid

Video Endoscopic Sequence 2 of 3.

A biopsy was performed, we noted that something hard was optained.

Guavas Seeds Incrusted in the Sigmoid

Video Endoscopic Sequence 3 of 3.

Some guavas seeds are observed.

Prominent Colonic Mucosal Scarring

Prominent Colonic Mucosal Scarring.

Splecnic Angle, prominent mucosal scarring with cicatricial mucosal bridges. A small segment of the colon was observed with this pattern, no additional data was obtained, no medical history of inflammatory bowel disease.

Colon sigmoid perforation.

Video Endoscopic Sequence 1 of 4.

Colon sigmoid perforation.

The image and the video display the epiplon which can be seen through the colonoscope.

This is the case of a 80 year-old lady who undewent a colonoscopy due to a cronic diarrhea, we had difficulty in advancing the colonoscope, between the the junction of ascending colon and cecum, and treated to make maneuvers to advance it, we asks the anesthesiologist depress the left colon and this made a very strong and with both hands the maneuver, in this way we get to fully examine the cecum.

Colon Perforation.

Video Endoscopic Sequence 2 of 4.

Colon Perforation.

The image displays a bluish structure which corresponds to the spleen.

Colon Sigmoid Perforation.

Video Endoscopic Sequence 3 of 4.

Colon Sigmoid Perforation.

Colon Sigmoid Perforation.

Video Endoscopic Sequence 4 of 4.

Colon Sigmoid Perforation.

A small submucous mass of the sigmoid colon is observed.

A submucous balancing is done when exerting a traction with the forceps of the biopsy.

In this case the endosonography would give a greater parameter in diagnosis.

Video Endoscopic Sequence 1 of 2.

Tablets of medicine found it in the colon.

A not yet dissolved tablets was found in the transverse colon and another one at the cecum.

Sometimes the laxative effect can push the tablets without being degraded.

Video Endoscopic Sequence 2 of 2.

This tablet was found at the cecum, the video clip displays the appendicular hole.

Video Endoscopic Sequence 1 of 2.

Rectal Trauma.

An 82 year-old Homosexual, with severe rectal hemorrhage due to rectal trauma with blunt object.

Video Endoscopic Sequence 2 of 2.

The hemorrhage was stopped using argon plasma coagulator.

Argon Plasma Coagulator is a new device that allows for non-contact monopolar coagulation of bleeding surfaces, and devitalization of tissue in the gastrointestinal tract.

It is safer and much less expensive than lasers, more effective than bipolar cauterization techniques.

Video Endoscopic Sequence 1 of 15.

This is the case of 74 year-old male, who has under screening of paraneoplastic syndrome the cat scan displays bilateral hydronephrosis with the thickening of the walls of urinary bladder and the retum.

The rectum display a cobblestone pattern , the biopsies did not displays malignancy.

Dilation with hydrostatic balloon

Video Endoscopic Sequence 2 of 15.

Consecutive colonoscopy with dilation was carried out.

The recto-sigmoid junction has a stricture.

Dilation with hydrostatic balloon

Video Endoscopic Sequence 3 of 15.

Dilation with hydrostatic balloon.

Hydrostatic balloon dilation is being increasingly used for gastrointestinal stenosis.

Dilation with hydrostatic balloon

Video Endoscopic Sequence 4 of 15.

Dilation of recto-sigmoid junction.

Dilation with hydrostatic balloon

Video Endoscopic Sequence 5 of 15.

Hydrostatic balloon dilation of gastrointestinal stenosis

Dilation with hydrostatic balloon

Video Endoscopic Sequence 6 of 15.

 

Dilation with hydrostatic balloon

Video Endoscopic Sequence 7 of 15.

The maneuvers of the splenic angle was difficult.

Dilation with hydrostatic balloon

Video Endoscopic Sequence 8 of 15.

This image represent that some anomalies are seen in the transverse colon, the are some blood.

Colonic Tears with perforation

Video Endoscopic Sequence 9 of 15.

Colonic Tears with perforation.

After the splenic angle was overcome, distantly of splenic angle in the transverse colon, we observed that something not is good; when we approached we saw that there are tears.

Evaluation of complications after colonoscopy requires a detailed history and careful physical diagnosis. In particular, the patient (and the endoscopist, if available), should be asked specifically about the anomalous findings and a full description of the symptoms which occurred after the procedure. The duration of the procedure, the quality of the bowel preparation, pain associated with the study, the amount of analgesia required, whether prolonged abdominal pressure was required (to control an intraabdominal colonic loop), whether biopsies or polypectomies were performed (and if so how many, location, size, with what technique, and with what hemostasis) all may help identify the exact injury.

Together with careful evaluation of the patient's medical condition and comorbidity, answers to these questions provide the surgeon with the information necessary to surmise what intervention, if any, the patient is likely to require.

 

Colonic Tears with perforation

Video Endoscopic Sequence 10 of 15.

Colonic Tears with perforation.

How is explained that the transverse colon was damage if the maneuvers were distantly in the splenic angle and the dilation were in the recto-sigmoid junction?.

The transverse colon was fixed with the mesocolon due to the mesocolon was thickened due to the metastasis of an adenocarcinoma, disabling the normal movements of displacement forwards and backwards that are caused with the colonoscopy.

The patient may present directly from the endoscopy suite, but more often there is an interval lasting from several hours to days. Typically, the patient complains of abdominal pain and distension, and objective findings may include leukocytosis and fever. However, up to ten percent of patients with perforation from colonoscopy are asymptomatic (Gebedou 1996). For suspected perforation in the patient without peritoneal signs, upright x-rays of the abdomen may demonstrate free air. However, the amount of free air evident on x-ray may not be an accurate indicator of the size of the defect. Some cases of contained perforation may only be detectable by CT scan.

 

Colonic Tears with perforation

Video Endoscopic Sequence 11 of 15.

Colonic Tears with perforation.

The patient has a large retroperitoneal mass with disseminated carcinomatosis

Perforation has been estimated to occur in approximately 0.2% of diagnostic colonoscopies and 0.6% of colonoscopies where biopsy is also performed (Gebedou 1996), but may in fact occur less frequently (Basson 1998). In 50–60% of cases, perforation occurs at the rectosigmoid region of the large bowel, with an additional 10–20% perforation rate at the cecum (Farley 1997). Because of its rarity and the likelihood of variations with regional colonoscopic practice patterns, useful data distinguishing the relative rates of “small” and “large” intestinal ruptures is not consistently available.

Colonic Tears with perforation

Video Endoscopic Sequence 12 of 15.

Colonic Tears with perforation

Since the advent of flexible fiberoptic endoscopes, colonic endoscopy has been a diagnostic and therapeutic modality shared by surgeons, gastroenterologists, and primary care practitioners. Unfortunately, increased use has been accompanied by a corresponding increase in the incidence of post-colonoscopy complications. Since these are uncommon, iatrogenic, and potentially subject to malpractice claims.

Colonic Tears with perforation

Video Endoscopic Sequence 13 of 15.

Colonic Tears with perforation

At that time we did not have hemoclips, now it would have been easier to close this hole with this tool, patient underwent a surgery, finding a a carcinomatosis.

Perforation is defined as a traumatic breach of intestinal integrity. Perforations may roughly be divided into those in which the injury is relatively small and those in which the injury is relatively large. In conjunction with the quality of the pre-colonoscopic bowel preparation, the patient's medical status, and the time between perforation and diagnosis, this distinction has important therapeutic and prognostic significance. Small perforations most intuitively result from direct mechanical trauma, such as the result of forceful passage of the tip of the endoscope through a diverticulum (misidentified as lumen), inadvertent penetration of the side of a tight flexure or bend, or tearing during traversal of a narrowed stricture. Theoretically, perforation may also occur from pneumatic forces, when attempts to increase visualization lead to over-distension. Although this mechanism is uncommon.

 

Colonic Tears with perforation

Video Endoscopic Sequence 14 of 15.

Colonic Tears with perforation.

More recent cadaver studies demonstrated that luminal pressure increases of 169 mmHg were necessary to rupture the sigmoid colon (Kozarek 1980). Finally, a small perforation may occur during the mechanical trauma of biopsy or the electrical and thermal injuries inherent in snare polypectomy or therapeutic cauterization.

Colonic Tears with perforation

Video Endoscopic Sequence 15 of 15.

Colonic Tears with perforation.

Large intestinal disruptions may unfortunately be as common as these small perforations. Substantial intestinal ruptures are caused by the lateral pressure of a bowed loop of colonoscope against a stretched loop of colon. Such pressure may split a loop of sigmoid or transverse colon longitudinally while the endoscopist attempts to advance the tip of the colonoscope more proximally. These tears are particularly dangerous both because of their large size and because they occur without direct visualization of the perforated area at the time of injury. The suspicion of such an injury militates very strongly against attempts at non-operative management, as such an injury should be managed by resection of the injured segment.

India ink tattoo

Video Endoscopic Sequence 1 of 4.

India ink tattoo

India ink tattoo is used as a guide for follow-up examinations, the tattoo may remain in the colon for the remainder of that patient's life.

Small colonic lesions which are identified during endoscopy are usually difficult to locate intra-operatively.

Endoscopic tattoo of the colon seems the most efficient method, however it does fail in some cases to identify the lesion preoperatively.

Colonic India ink tattoo

Video Endoscopic Sequence 2 of 4.

The clinical utility of endoscopic tattooing of the colon to permit accurate intraoperative localization of small or nonpalpable lesions.

Precise knowledge of a lesion's location in the colon is infrequently required. Occasionally, however, this information can be of critical clinical importance.

A variety of endoscopic and radiologic techniques have been described to localize an area or site within the colon.

Tissue staining or tattooing is the most reliable endoscopic method of colon lesion localization, and India ink provides a long-lasting and probably permanent tattoo of the site. Endoscopic clips are less reliable and remain cumbersome to use.

Electronic imaging is an intriguing approach but remains experimental. Sites and lesions also can be identified by barium radiography or fluoroscopy, but these techniques involve added expenses and are not as reliable as tattooing with India ink.

 

 

 

India ink tattoo of Colon

Video Endoscopic Sequence 3 of 4.

Anastomosis ileum colon

India ink tattoo of Colon

Video Endoscopic Sequence 4 of 4.

Rest of surgical material are observed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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