# September 2024 colonoscopy private abstraction

Source: `/root/health/private/colonoscopy-2024-09-02/Koloskopi_- edi_02-09-2024_kl_1005.pdf`
Email source: Dag Erlandsen -> dorian.westby@proton.me, subject `coloscopy report`, received 2026-05-04 UTC.
Privacy rule: source PDF and extracted images stay local under `/root/health/private/colonoscopy-2024-09-02/`; do not embed the images in any public/front-facing health report.

## Report text abstraction

- Date/facility: 2024-09-02 colonoscopy, Lovisenberg Diakonale Sykehus, medical department.
- Indication: blood in stool and elevated CEA; CRC package pathway.
- Pre-procedure context recorded in report: one episode of fresh blood/clot over stool; Hb 13.2; ferritin 95; transferrin saturation 40%; no anticoagulant use.
- Prep: Plenvu + Toilax.
- Bowel preparation quality: good, BBPS 3+3+3 = 9.
- Sedation: alfentanil IV 0.5 + 0.25 mg; sedation quality good.
- Technique: distal cap and hydrocolonoscopy. Sigmoid colon described as fixed with sharp bends; loops required repositioning/external pressure and second endoscopist help, but instrumentation was completed without complication.
- Extent/completeness: terminal ileum reached and examined 15 cm beyond the ileocecal valve/valvula Bauhini.
- Perianal/rectal exam: perianal inspection unremarkable; digital rectal exam normal.
- Terminal ileum: normal mucosa/villi; no inflammation or ulcers.
- Colon: shiny/normal mucosa in all segments; no inflammation; no polyps.
- Diverticula: scattered small diverticula from right flexure to sigmoid colon.
- Rectum: retroflexed/inverted scope exam without pathology, specifically no polyps.
- Assessment: diverticulosis from right flexure to sigmoid; otherwise no pathology; no evidence of malignancy; CRC package closed.
- Diagnosis: K57.3 diverticular disease of colon without perforation or abscess.
- Missing/not stated: withdrawal time not seen in extracted text; no explicit surveillance interval seen; no biopsy/pathology details because no lesion/biopsy is described.

## Image review abstraction

Images reviewed from local extracts only:

- `/root/health/private/colonoscopy-2024-09-02/images/page-02.png`
- `/root/health/private/colonoscopy-2024-09-02/images/embedded-p02-01.jpeg` through `embedded-p02-05.jpeg`

Visual review summary:

- Page captions/landmarks include appendiceal orifice/cecal area (`Appendixvedhenget`), diverticula (`Divertikler`), and rectum on retroflexion (`Rectum, invertert skop`).
- The page/image set visually supports cecal landmark documentation and rectal retroflexion documentation.
- Diverticula are visible and consistent with the written diverticulosis finding.
- Visible mucosa appears generally smooth/pink/glossy with good visualization.
- No obvious polyp, mass, ulceration, active bleeding, diffuse colitis/inflammation, or poor bowel prep is visible in the still images reviewed.

Important limitation: still images cannot substitute for the full video/endoscopist exam. They can support report-quality abstraction but cannot independently prove every mucosal surface was inspected.

## Decision impact for KB

- The prior uncertainty item is largely resolved: this was a complete, high-quality colonoscopy by documented BBPS 9 and terminal-ileum intubation, with cecal/appendiceal and rectal retroflexion images.
- This raises the threshold for automatic early repeat colonoscopy after April 2026 occult blood if repeat stool and iron/Hb markers normalize.
- It does not close the current occult-blood branch: persistent FOB/RBC, falling ferritin/TSAT/Hb/MCV drift, visible bleeding, melena/upper-GI symptoms, weight loss, progressive bowel-habit change, or clinician concern still warrant GI-source review.
- Because the colonoscopy was adequate and unrevealing for malignancy/polyps in 2024, persistent occult blood after stable repeat lower-GI review may shift attention to anorectal sources, upper-GI evaluation, or small-bowel workup depending on symptom/iron pattern and clinician judgment.