CPT® Code 45337

Sigmoidoscopy, flexible; with decompression (for pathologic distention) (eg, volvulus, megacolon), including placement of decompression tube, when performed

A flexible sigmoidoscopy is a diagnostic and therapeutic procedure that involves the use of a flexible tube equipped with a light and camera, known as a sigmoidoscope, to examine the lower part of the colon, specifically the sigmoid colon and rectum. This procedure is particularly indicated for patients experiencing pathologic distention of the colon, such as conditions like volvulus or megacolon. Volvulus refers to the twisting of the intestine around its mesenteric pedicle, which can lead to obstruction and result in a segment of the intestine becoming distended with feces and gas. This condition is often associated with long-standing constipation, which can cause the colon to become elongated and atonic, leading to what is termed acquired megacolon. If left untreated, volvulus can result in serious complications, including tissue infarction due to compromised blood supply and potential perforation of the bowel, which can lead to peritonitis, a life-threatening condition. During the procedure, the sigmoidoscope is inserted through the anus and advanced through the rectum to the site of the obstruction, utilizing air insufflation to expand the colon and allow for a thorough inspection of the mucosal lining for any signs of ischemia or necrosis. If the mucosa appears intact, a decompression tube may be placed to relieve the obstruction, allowing for the evacuation of trapped gas and fecal matter, thereby alleviating the patient's symptoms and preventing further complications.