S.M., a 24-year-old man, had a recent history of lower abdominal pain with frequent loose mucoid stools. He described symptoms of occasional dysphagia, dyspepsia, nausea, and aphthous ulcers of his tongue and buccal mucosa. A previous barium enema showed some irregularities in the sigmoid and rectal segments of his large bowel. Stool samples for culture, ova, and parasites were negative. His tentative diagnosis was irritable bowel syndrome.

He followed a lactose-free, low-residue diet and took Imodium to reduce intestinal motility. His gastroenterologist recommended a colonoscopy. After a 2-day regimen of soft to clear liquid diet, laxatives, and an enema the morning of the procedure, he reported to the endoscopy unit. He was transported to the procedure room. ECG electrodes, a pulse oximeter sensor, and a blood pressure cuff were applied for monitoring, and an IV was inserted in S.M.'s right arm. An IV bolus of Demerol and a bolus of Versed were given, and S.M. was positioned on his left side. The colonoscope was gently inserted through the anal sphincter and advanced proximally. S.M. was instructed to take a deep breath when the scope approached the splenic flexure and the hepatic flexure to facilitate comfortable passage. 

The physician was able to advance past the ileocecal valve, examining the entire length of the colon. Ulcerated granulomatous lesions were seen throughout the colon, with a concentration in the sigmoid segment. Many biopsy specimens were taken. The mucosa of the distal ileum was normal. Pathology examination of the biopsy samples was expected to establish a diagnosis of IBD.

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