Visual examination of the anal canal and rectum frequently is omitted by the pediatrician because the procedure is thought to be dangerous, difficult, too time consuming, or unrewarding. Nevertheless there are many definite indications for this procedure; for example, prolonged or unexplained diarrhea, abdominal pain of unknown etiology, the passage of tarry stools, blood, pus, or mucus, unexplained protracted fever, and local conditions such as perianal fistulae and abscesses. It also may be indicated in unexplained vaginal discharge or recurrent cystitis in either sex. Furthermore it is just this portion of the gastrointestinal tract concerning which it is most difficult to obtain information by a barium enema examination. Specimens for bacteriological and parasitological studies of rectosigmoidal lesions are best obtained directly from the lesion through the proctoscope. There are very few contraindications to the procedure, the most important of which is that it should never be attempted unless a thorough
HIJMANS JC. Proctoscopy of the Infant. Am J Dis Child. 1963;105(3):297–299. doi:10.1001/archpedi.1963.02080040299014
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