Foam

Faecal residue with a foamy appearance is mostly detected in the cecum or ascending colon. It appears as an amorphous inhomogeneous mixture mostly of air bubbles and stool. They occur in both preparations without and with faecal tagging. In the latter case the foam is tagged or non-tagged. This foam may distract the reader's attention or cover a lesion making detection difficult (Fig 4.19).

Fig. 4.16.a Non-tagged fluid covering 25-50% of the colonic lumen at the hepatic flexure in supine position (white arrows). Tagged residue in the fluid (open black arrowhead). b In the prone position the fluid is redistributed to the anterior part of the hepatic flexure (white arrowheads) and the transverse colon (black arrowhead) enabling complete visualisation of the colonic wall. Tagged residue is visible (black arrow)

Fig. 4.16.a Non-tagged fluid covering 25-50% of the colonic lumen at the hepatic flexure in supine position (white arrows). Tagged residue in the fluid (open black arrowhead). b In the prone position the fluid is redistributed to the anterior part of the hepatic flexure (white arrowheads) and the transverse colon (black arrowhead) enabling complete visualisation of the colonic wall. Tagged residue is visible (black arrow)

Fig. 4.17.a Supine view of the transverse colon showing a mucous filament (white arrowhead) attached to a prominent semicircular fold (white arrow), mimicking a stalked polyp. Some partially tagged foam (black arrowhead). b Corresponding endolu-minal view showing the filament mimicking the stalk of a polyp (white arrows). The filament has an irregular shape. The foam is also visible (black arrows)

Fig. 4.17.a Supine view of the transverse colon showing a mucous filament (white arrowhead) attached to a prominent semicircular fold (white arrow), mimicking a stalked polyp. Some partially tagged foam (black arrowhead). b Corresponding endolu-minal view showing the filament mimicking the stalk of a polyp (white arrows). The filament has an irregular shape. The foam is also visible (black arrows)

Fig. 4.18.a Polyp with a small stalk in the descending colon (white arrows). b Corresponding endoluminal view showing the stalk (white arrows) and the head (white arrowhead) of the polyp b

Fig. 4.18.a Polyp with a small stalk in the descending colon (white arrows). b Corresponding endoluminal view showing the stalk (white arrows) and the head (white arrowhead) of the polyp a

Fig. 4.19.a Non-tagged foam with some tiny tagged residue besides a possible sessile polyp (black arrowhead) in the ascending colon (supine view). b Corresponding prone view: the foam has moved to the anterior border of the ascending colon (white arrow). The sessile lesion remains unchanged (black arrowhead) and should be considered a sessile polyp. The lesion was confirmed on optical colonoscopy b

Fig. 4.19.a Non-tagged foam with some tiny tagged residue besides a possible sessile polyp (black arrowhead) in the ascending colon (supine view). b Corresponding prone view: the foam has moved to the anterior border of the ascending colon (white arrow). The sessile lesion remains unchanged (black arrowhead) and should be considered a sessile polyp. The lesion was confirmed on optical colonoscopy a

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