Rectum & Colon Flashcards
(127 cards)
1
Q
📖Types of colorectal polyps?
A
- pedunculated polyp:polyp has a stem
- sessile polyp: flat polyps
2
Q
✂️Histologically, most polyps are🧷🧷🧷🧷🧷🧷
A
benign tubular adenomas
📝Full resection of these polyps does not require further intervention.
3
Q
✂️The polyp is considered invasive carcinoma when tumor cells invade🧷🧷🧷🧷🧷
A
muscularis mucosa
4
Q
What is the best next step after identifying a 1 cm pedunculated sigmoid polyp with adenocarcinoma invading only the submucosa and no distant spread⁉️
A
✅ Sigmoidectomy
➡️ Because cancer invaded the submucosa, surgical resection is needed to ensure complete excision and check for lymphovascular invasion or residual tumor.
5
Q
What key colonoscopic and pathology findings indicate the need for surgical resection after polypectomy⁉️
A
🚩 Invasion of submucosa
🚩 Adenocarcinoma on biopsy
🚩 Polyp size ≥1 cm
➡️ These findings raise concern for residual tumor or lymph node spread.
6
Q
What histological polyp types have a higher risk of malignancy⁉️
A
⛔ Villous and tubulovillous adenomas
⚠️ Risk increases with polyp size
➡️ Villous >2 cm = >50% malignancy risk
💡 Tubular adenomas <1 cm = ~5% risk
7
Q
Does a completely resected benign tubular adenoma require additional treatment⁉️
A
✅ No
➡️ Full removal of a non-malignant polyp (especially if <1 cm) requires surveillance only, not further intervention.
7
Q
What does T1 stage indicate in colon cancer TNM staging⁉️
A
✅ Tumor invades submucosa only ➡️ Early-stage lesion with favorable prognosis.
7
Q
How is N staging defined in colon cancer⁉️
A
🚩 N0 – No regional lymph node metastasis
🚩 N1 – 1–3 positive lymph nodes
🚩 N2 – ≥4 positive lymph nodes
8
Q
What is considered M1 in colon cancer staging⁉️
A
🚨 Presence of distant metastasis
9
Q
What is the standard follow-up protocol after colon cancer surgery⁉️
A
📅CEA every 6 months for 5 years ➡️ then yearly
📅 Colonoscopy 1 year after surgery ➡️ then every 3 years if clean
🖥️ Chest + abdominal CT every year
🧠 CEA = Carcinoembryonic Antigen
10
Q
What is the treatment and prognosis for Stage 1 colon cancer (T1/2 N0 M0)⁉️
A
✅ Surgery alone
🧠 5-year survival ≈ 90%
11
Q
What is the treatment and prognosis for Stage 2 colon cancer (T3/4 N0 M0)⁉️
A
✅ Surgery (in general)
🧠 5-year survival ≈ 75%
12
Q
What is the treatment and prognosis for Stage 3 colon cancer (N1/2 M0)⁉️
A
✅ Surgery ➕ Adjuvant chemotherapy:
➡️ FOLFOX (5-FU + Leucovorin + Oxaliplatin)
➡️ OR CAPOX (Capecitabine + Oxaliplatin)
🧠 5-year survival ≈ 50%
13
Q
What is the treatment strategy for Stage 4 colon cancer (M1)⁉️
A
🚩 If unresectable: Chemotherapy ± targeted therapy (e.g., cetuximab)
🚩 If few resectable liver metastases: ➡️ Resection + chemo
5-year survival:
⛔ 5% (nonresectable)
✅ 60% (if resectable liver mets)
14
Q
What are the major poor prognostic factors in colon cancer⁉️
A
⚠️ Lymph node involvement
⚠️ Liver metastases < 1 year after diagnosis
⚠️ CEA > 200 ng/mL
⚠️ >5 cm hepatic mets
⚠️ High-grade or mucinous/signet ring adenocarcinoma
⚠️ Bilobar liver involvement
⚠️ Lymphovascular/perineural invasion
⚠️ Extrahepatic metastases
15
Q
What are the CEA monitoring guidelines after colon cancer surgery⁉️
A
✅ CEA (Carcinoembryonic Antigen) every 6 months for 5 years
➡️ Then annually
⚠️ If CEA is rising ➡️ do PET scan to assess for recurrence/metastases
(Carcinoembryonic Antigen)
16
Q
When should colonoscopy be done after colon cancer surgery⁉️
A
✅ 1 year after surgery
➡️ If clear ➡️ repeat every 3 years
⚠️ If adenomas found ➡️ repeat annually until colon is clean
17
Q
What imaging is recommended postoperatively in colon cancer patients⁉️
A
✅ Chest and abdominal CT every year
🧠 To monitor for local or distant recurrence
18
Q
How are colorectal polyps classified based on endoscopic appearance⁉️
A
➡️ Pedunculated = with a stalk
➡️ Sessile = flat
19
Q
What are the major types of colorectal polyps based on histology⁉️
A
🔹 Non-neoplastic:
▪️ Hyperplastic
▪️ Inflammatory
▪️ Hamartomas (e.g., Peutz-Jeghers)
🔹 Neoplastic:
▪️ Serrated
▪️ Adenomas (tubular, villous, tubulovillous)
▪️ Carcinomas
20
Q
What features increase malignancy risk in neoplastic colorectal polyps⁉️
A
🚩 Size (larger = more risk)
🚩 Shape (sessile > pedunculated)
🚩 Histologic type (villous > tubular)
🚩 Grade of dysplasia
21
Q
What are the indications for colectomy in colorectal polyps⁉️
A
🚨 Colectomy is indicated if:
✔️ Pedunculated polyp Haggitt level 4
✔️ Sessile polyp Kikuchi level SM2/SM3
✔️ Poor histologic differentiation
✔️ Lymphovascular invasion
✔️ Incomplete removal or positive margins
22
Q
What clinical classification is used to assess severity of diverticulitis⁉️
A
✅ Hinchey classification is used to stage diverticulitis and guide treatment decisions.
(Other scoring systems like Ranson or APACHE are for pancreatitis, not diverticulitis.)
23
What does **Hinchey Stage 1a** represent in diverticulitis⁉️
👉🏼 Confined pericolic inflammation or phlegmon
🧠 Typically managed conservatively with antibiotics.
24
What is Hinchey Stage **1b** in diverticulitis⁉️
👉🏼 **Confined pericolic abscess**
💡 May be managed with antibiotics ± percutaneous drainage.
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What is defined as Hinchey **Stage 2** in diverticulitis⁉️
👉🏼 **Pelvic, intra-abdominal, or distant abscess**
🚩 Requires antibiotics and usually image-guided drainage.
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What is the **hallmark** of Hinchey **Stage 3** in diverticulitis⁉️
👉🏼 **Generalized purulent peritonitis**
🚨 Requires emergency surgery.
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What does Hinchey **Stage 4** indicate in diverticulitis⁉️
👉🏼 **Fecal peritonitis** due to colonic perforation
🚨 Surgical emergency with high morbidity.
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🚩 Haggitt **Level 0** definition & management?
**Tumor limited to mucosa** (carcinoma in situ)
👉🏼 Polypectomy is curative; no further surgery.
29
🚩 Haggitt **Levels 1–3** define what depth of invasion & what is the key management rule?
🧠**Invasion into submucosa of the polyp head (1), neck (2), or stalk (3).**
🧠💡 If completely excised with ≥2‑mm clear margins & no poor features, ✅ no colectomy needed.
30
🚨 What does Haggitt **Level 4** signify in pedunculated polyps, and how are all sessile invasive polyps classified?
**Tumor invades submucosa below the stalk into bowel wall.**
⚠️ All sessile polyps with invasive carcinoma are automatically Level 4.
👉🏼 Segmental colectomy with lymphadenectomy recommended due to ↑ risk of nodal metastasis.
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Which Haggitt levels have the **highest risk** of nodal / distant spread and therefore trigger formal colonic resection?
**Level 4** (plus any polyp with poor histology, lymphovascular invasion, or positive/close margins).
32
🧠 Why is the Haggitt system **clinically important**?
Stratifies pedunculated colorectal polyps by metastatic risk ➡️ guides need for polypectomy alone vs colectomy.
33
🧠 Which colonic polyp subtype carries the **greatest malignant potential** if left unresected?
**Adenomatous** (neoplastic) polyp—especially villous or tubulovillous and those >1 cm.
34
🚩 Name **four** non‑neoplastic polyp types and their usual cancer risk.
▸ **Hyperplastic** – ⛔ negligible risk
▸ **Inflammatory** – ⛔ negligible, reactive to mucosal injury/IBD
▸ **Hamartomatous** (e.g., Peutz‑Jeghers) – generally low, except in genetic syndromes
▸ **Mucosal/lymphoid polyps** – ⛔ no malignant potential
35
👉🏼 Key features that **increase adenoma malignancy** risk?
* **Size > 10 mm**,
* **villous histology**,
* **high‑grade dysplasia**,
* **multiplicity**,
* **serrated architect**
36
⚠️ **Management** rule for **adenomatous** polyps detected on colonoscopy?
**Complete endoscopic excision** followed by surveillance colonoscopy at guideline‑based intervals.
37
🧠 What is another name for an **abdominoperineal resection**?
**Miles procedure** (first described by Ernest Miles). ✅
38
🚩 Core components of **APR** surgery?
👉🏼 **Complete excision of rectum** + **anal canal** (with sphincters) through combined abdominal & perineal approach ➡️ perineal wound closure ➡️ permanent end‑colostomy.
39
⚠️ **Primary** indications for **APR**?
* **Tumor invading or abutting anal sphincters** (margin unattainable)
* **Patient factors precluding sphincter‑saving surgery**
* **Pre‑existing poor sphincter control/incontinence**.
40
⛔️ What **misconception** about **APR stoma** creation should be avoided?
A stoma **cannot** be avoided—permanent colostomy is integral to **APR**.
41
🧠 In older or preoperatively incontinent patients, why might **APR** be **favored over** low anterior resection (coloanal anastomosis)?
**Permanent colostomy** often yields better quality of life than a low anastomosis with poor postoperative continence.
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🚩 What is the **management** for a T1 N1a (Stage IIIa) colon adenocarcinoma resected by right hemicolectomy?
**Adjuvant chemotherapy** 🧠💡 (all Stage III colon cancers benefit from postoperative systemic therapy)
43
⚠️ When does the vast majority of colon‑cancer **recurrence** occur after curative resection?
**Within the first 2 years** after surgery (≈ 85 % of recurrences) ⚠️
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🚩 Which **adjuvant** regimen is **standard** for Stage III colon cancer after curative colectomy?
**FOLFOX** ✅ (5‑fluorouracil + leucovorin + oxaliplatin)
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⚠️ Why is **adjuvant** chemotherapy **mandatory** in **Stage III** disease (any N⁺)?
🧠**Lymph‑node involvement** → ↑ recurrence risk; chemo cuts relapse & boosts 5‑yr survival
46
👉🏼 5‑year overall survival with Stage III colon cancer + chemo?
**~ 50 %**
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⛔ Is **surveillance** alone acceptable for **Stage III** colon cancer?
⛔**No**
– follow‑up alone suits Stage I–II low‑risk, but N⁺ patients need systemic therapy
48
⛔ Does **colon cancer** ever receive adjuvant pelvic radiation?
⛔**No**
– radiation is reserved for rectal cancer, not colon
49
💡 When do most **recurrences** occur post‑resection regarding colon cancer?
**Within the first 2 years** (≈ 85 %) – guides intensive follow‑up
50
🚩 **1st‑line** (“1st intention”) therapy for Ogilvie’s syndrome?
**Supportive care**
➡️ NPO, correct fluids/electrolytes, stop culprit drugs, NG + rectal tube decompression * Indicated if cecum < 12 cm & no ischemia / perforation
51
⚠️ Which **meds** should be **avoided** during supportive phase regarding tratment of Ogilvie’s syndrome?
**Osmotic / stimulant laxatives**
⛔ – worsen colonic dilatation
52
👉🏼 **2nd‑line** pharmacologic agent when supportive care fails regarding tratment ofOgilvie’s syndrome?
**Neostigmine** (IV acetylcholinesterase inhibitor) ✅ – enhances parasympathetic tone
53
⚠️ Neostigmine key **side‑effects** & **contraindications** regarding treatment of Ogilvie’s syndrome??
**Side‑effects:** bradycardia, crampy pain, vomiting 🤢
* **Contra:** mechanical SBO, ischemia, perforation 🚨
54
🧠 **3rd‑line procedure** if cecum > 12 cm or no response / contraindication to neostigmine in **Ogilvie’s syndrome**?
**Endoscopic decompression** (flexible colonoscopic tube)
55
🚨 **4th‑line:** operative indications for Ogilvie’s syndrome?
➡️**Failure of other steps** or
➡️**signs of systemic toxicity**,
➡️**ischemia**,
➡️**perforation**,
➡️**cecal diameter > 12 cm with tenderness**
56
🚨 **Management** of Left‑Sided Obstructing Colon Cancer in a **Hemodynamically unstable** OR **perforation/ischemia of proximal colon**?
**Hartmann‑type surgery**
➡️ Emergency sigmoid/left colectomy + end stoma (no primary anastomosis)
57
⚠️**Management** of Left‑Sided Obstructing Colon Cancer **Stable patient** **but** proximal bowel looks threatened (early ischemia / impending perforation)?
**Subtotal colectomy + ileocolostomy stoma**
✅ – removes distended colon & avoids anastomosis under stress
58
**Management** of Left‑Sided Obstructing Colon Cancer in a **stable**, **no** ischemia/perforation, good tissue, tension‑free ends?
**On‑table sigmoid**/**left colectomy** + **primary colorectal anastomosis**
59
**Management** of Left‑Sided Obstructing Colon Cancer in** Stable**, and **safest** to defer definitive colectomy (**bridge strategy**)?
**Endoscopic self‑expanding metal stent** (SEMS) 👉🏼 decompress, convert to elective resection later
60
🚩 What is the** FIRST operative** choice for left‑sided obstruction with cecal perforation/ischemia?
**Subtotal colectomy** ➡️ end stoma (no anastomosis).
🧠 Subtotal = remove colon en bloc to eliminate ischemic/proximal blow‑out risk.
61
How do you manage an **unstable patient** with obstructing sigmoid cancer but no cecal blow‑out?
**Sigmoidectomy** ➡️ end colostomy (Hartmann procedure).
⚠️ Unstable = avoid primary anastomosis.
62
How do you manage a case of sigmoid cancer **stable left‑side obstruction** healthy bowel ends, tension‑free reach—preferred operation?
**Sigmoidectomy + primary colorectal anastomosis**.
✅ Good perfusion & low tension = anastomosis acceptable.
63
Management of **right‑sided obstructing** sigmoid tumor in an unstable / high‑risk patient?
**Right hemicolectomy + diverting stoma (no anastomosis)**.
🚨 Protects against anastomotic leak in compromised host.
64
Preferred surgery for **stable** **right**‑sided **sigmod** obstruction with low leak risk?
**Right hemicolectomy + primary ileocolic anastomosis**.
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💡 **List** the algorithm triggers that push you away from primary anastomosis (any side).
Ischemia ➡️ perforation ➡️ peritonitis ➡️ hemodynamic instability ➡️ poor perfusion/tension.
⚠️ **Any present = create stoma**.
66
🧠 What is **sigmoid volvulus**, and why is it clinically important?
**Twisting of the sigmoid colon on its mesenteric axis** ➡️ l**Large‑bowel obstruction** (≈ ⅓ of global cases)
⚠️ may cut off blood supply → ischemia.
67
List the **top 3 risk factors** for sigmoid volvulus.
➡️**Chronic constipation**
➡️ **advanced age** (7ᵗʰ‑8ᵗʰ decade)
➡️ **psychiatric patients on psychotropic drugs.**
68
Classic **X‑ray** & **CT** findings that clinch the diagnosis?
**X‑ray:** “coffee‑bean” / bent inner‑tube sign dilating into RUQ.
**CT:** mesenteric “whirl” pattern (swirled vessels).
✅ Quick imaging = rapid triage.
69
**First‑line** management of Sigmoid Volvulus algorithm for **stable** patients **without** peritonitis/ischemia?
🚩**Step 1:** NPO + IV fluids & electrolyte correction.
🚩**Step 2:** Endoscopic detorsion by rectal tube or flexible sigmoidoscope.
🧠 High success, buys time for elective resection.
70
When must you **skip** endoscopic decompression and **operate** emergently regarding sigmoid volvulus?
⚠️**Peritoneal signs, severe pain, rebound tenderness, systemic toxicity**
➡️ **concern for colonic necrosis**
🧠 laparotomy with sigmoid colectomy, rectal stump closure, end colostomy.
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Post‑detorsion **definitive** treatment to **prevent recurrence**?
**Elective sigmoid colectomy with primary anastomosis** (fit patient) or **Hartmann procedure** (high‑risk).
⚠️ Recurrence rate high without resection.
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What **imaging finding** is typically seen in Ogilvie’s syndrome?
**Dilated colon** (often entire colon), especially cecum >9–10 cm, **without** mechanical obstruction.
73
What is the **first-line treatment** for Ogilvie’s syndrome in a **stable** patient with **no** peritonitis or ischemia and a cecum <12 cm?
* **Conservative management:**
NPO, IV fluids, electrolyte correction, bowel rest, and NG/rectal tube decompression.
74
What is the **next best step** in a patient with **Ogilvie’s syndrome** who fails conservative management after 48–72 hours or has a cecum ≥10–12 cm with no signs of ischemia?
**Neostigmine administration** (cholinesterase inhibitor to stimulate colonic motility).
75
What is a **major contraindication** to neostigmine use in Ogilvie’s syndrome?
🚨**Bradycardia**,
🚨**active bronchospasm**
🚨**signs of bowel perforation/peritonitis**.
76
When is **colonoscopy** indicated in Ogilvie’s syndrome?
If **neostigmine fails** or is **contraindicated**; it’s used for decompression but carries risk of perforation.
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When is **surgery** (e.g., subtotal colectomy) indicated in Ogilvie’s syndrome?
Only if there are signs of **colonic perforation**, **ischemia**, or **peritonitis**.
78
What is the **most appropriate next step** in this case scenario (POD 7, cecum ~10 cm, no peritonitis, failed conservative management)?
**Administration of neostigmine.**
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What is colonic pseudo-obstruction (**Ogilvie’s syndrome**)?
A condition **mimicking** large bowel obstruction with **colonic distension** on imaging but **no** mechanical cause found.
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What are **common risk factors** for developing **Ogilvie’s syndrome**?
📌**Use of neuroleptics**
📌 **opiates**
📌 **metabolic imbalances**
📌 **diabetes**
📌**myxedema**
📌**uremia**
📌**lupus**
📌**scleroderma**
📌**Parkinson’s**
📌 **retroperitoneal hematoma**
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What is the proposed **pathophysiology** of colonic pseudo-obstruction(**Ogilvie’s syndrome**)?
**Autonomic imbalance**—hyperactive sympathetic activity suppresses parasympathetic (colonic motility).
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What are the **two types** of colonic pseudo-obstruction(**Ogilvie’s syndrome**)?
📌**Acute type:** Affects only the colon, seen in patients with chronic cardio-pulmonary or neurologic conditions.
📌**Chronic type:** Involves the whole digestive system with episodic partial bowel obstruction.
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Which colonic segments are **most distended** in Ogilvie’s syndrome?
📌The right colon and transverse colon (especially **the cecum**).
84
What are the **imaging modalities** used to diagnose Ogilvie’s syndrome?
📌**Abdominal X-ray:** Shows colonic dilation.
📌**Contrast enema or CT:** Excludes mechanical obstruction.
📌**Colonoscopy:** May be used to exclude obstruction or for decompression.
85
What is the **first-line treatment** for colonic pseudo-obstruction?
**Supportive care:**
📌NGT decompression,
📌IV fluids,
📌electrolyte correction,
📌 stopping exacerbating medications (e.g., opioids, anticholinergics).
86
What **precaution** must be taken during** neostigmine** administration?
⚠️Monitor for **bradycardia**; give under supervision with **atropine** readily available.
87
What are the **non-surgical** decompression options if **neostigmine** fails or is contraindicated?
**Colonoscopy decompression** or **epidural anesthesia** (both carry risk of perforation).
88
When is **surgical** intervention indicated in colonic pseudo-obstruction?
If the patient develops signs of **perforation**, **ischemia**, or **fails** all conservative/decompression methods.
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What is the **preferred surgical procedure** in **Ogilvie’s syndrome** with perforation or ischemia?
📌 **Loop colostomy** with excision of necrotic segments.
90
What distinguishes **mechanical** vs **non-mechanical** (pseudo) colonic obstruction in terms of pathophysiology?
📌**Mechanical:** Physical blockage (tumor, volvulus, adhesions).
📌**Pseudo-obstruction:** Functional impairment due to poor colonic motility without blockage.
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What **radiological finding** helps differentiate **Ogilvie syndrome** from **mechanical large bowel obstruction**?
📌**Gas seen in the rectum** on X-ray (indicates no mechanical obstruction).
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When does **Ogilvie syndrome** most commonly occur?
📌In **elderly patients** with **multiple comorbidities**, usually postoperatively.
93
What is the underlying **pathophysiology** of Ogilvie syndrome?
📌**Dysregulation of colonic autonomic innervation** → ↑ sympathetic activity > ↓ parasympathetic tone.
94
What are the **main clinical** features of Ogilvie syndrome?
📌**Abdominal distension**
📌**pain**
📌**nausea/vomiting**
📌**decreased or absent bowel sounds**.
95
What **diagnostic tests** are used in suspected Ogilvie syndrome?
📌**Labs:** CBC, electrolytes, renal function
📌**Imaging:** Abdominal X-ray (dilated colon), CT (confirmatory)
96
**List** some associated conditions with Ogilvie syndrome.
📌**Post-surgical states** (esp. cardiac or abdominal)
📌**Neurologic** (Parkinson’s, Alzheimer’s, stroke, spinal injury)
📌**Cardiac** (CHF, MI)
📌**Pulmonary** (COPD)
📌**Metabolic** (diabetes, renal failure, electrolyte issues)
📌**Trauma**
📌**infections** (CMV, VZV)
📌**Medications** (opiates, chemo, antipsychotics, anticholinergics, clonidine)
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What **age** group and **gender** are most commonly affected by **rectal prolapse**?
📌**Women over age 50.**
98
What are the most common **symptoms** of rectal prolapse?
📌**Protruding rectal mass after defecation**
📌**Sensation of incomplete evacuation**
📌**Fecal incontinence**
📌**Mucous discharge or perianal wetness**
99
What is the relationship between **chronic constipation** and **rectal prolapse**?
📌Chronic constipation is **a major risk factor**, present in over 50% of cases.
100
What are **potential complications** of chronic rectal prolapse?
📌**Ulceration**
📌**bleeding**
📌**thickened mucosa**
📌**incarceration** (may require emergency surgery).
101
How does **rectal prolapse** typically **progress** over time?
📌**Early:** spontaneous reduction after defecation
📌**Later:** persistent prolapse with possible incarceration and complications
102
What **additional evaluations** should be done in patients with **rectal prolapse**?
📌**Assessment for other pelvic floor disorders** (e.g., urinary incontinence, vaginal vault prolapse)
📌**colonoscopy** to rule out colon cancer.
103
Why should **colonoscopy** be done **before** rectal prolapse **surgery**?
📌 **To rule out** colon cancer as a potential lead point for prolapse.
104
What are the **two** main **surgical** approaches to rectal prolapse?
📌**Perineal approach** (Delorme, Altemeier)
📌**abdominal approach** (rectopexy with/without resection).
105
What is the **preferred** surgical approach for rectal prolapse in **elderly** or **high-risk patients**?
📌**Perineal approach** — fewer morbidities, but higher recurrence rate.
106
Which surgical approach is **preferred** in **young** or **fit patients** with rectal prolapse and pelvic floor dysfunction?
📌**Abdominal approach** (laparoscopic, robotic, or open rectopexy).
107
How can **rectal prolapse** be distinguished from **internal hemorrhoids** on physical exam?
📌**Rectal prolapse:** concentric circular folds, painless
📌**Hemorrhoids:** radial folds, may be painful (especially external hemorrhoids)
107
Why are internal hemorrhoids **not** confused with rectal prolapse?
📌**Internal hemorrhoids** form radial folds and typically protrude with pain or bleeding
📌**rectal prolapse** is painless with concentric folds.
108
What **distinguishes** rectal prolapse from internal hemorrhoids on physical exam?
📌**Rectal prolapse:** concentric (circular) peripheral folds, painless
📌**Internal hemorrhoids:** radial folds, often painful or bleeding
109
How much **fluid** can the colon absorb per day?
📌Up to **5 liters** of fluid per day.
110
Why is **external hemorrhoid** an incorrect diagnosis in painless rectal protrusion?
📌External hemorrhoids are usually **painful** and do not create concentric mucosal folds like rectal prolapse.
111
Why is **giant rectal polyp** an unlikely diagnosis in visible rectal protrusion?
📌**Rectal polyps** are diagnosed by **colonoscopy** and do not prolapse through the anus.
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