Evaluation of adult cases presenting with bleeding per rectum

Authors

  • Arun R. Department of General Surgery, Government Medical College, Baroda, Gujarat, India
  • Dilip B. Choksi Department of General Surgery, Government Medical College, Baroda, Gujarat, India
  • Milind Patil Department of General Surgery, Government Medical College, Baroda, Gujarat, India
  • Pooja Shah Department of General Surgery, Government Medical College, Baroda, Gujarat, India
  • Sahdevsinh Chauhan Department of General Surgery, Government Medical College, Baroda, Gujarat, India

DOI:

https://doi.org/10.18203/2349-2902.isj20204666

Keywords:

Bleeding per rectum, Rigid sigmoidoscopy, Colonoscopy

Abstract

Background: Aim of the study was to find out various proportion of diseases responsible for bleeding per rectum in adults and to find out diagnostic utility of anoproctoscopy, rigid sigmoidoscopy and colonoscopy for patients with bleeding per rectum. It also aims to find out the usefulness of other investigations like upper GI scopy, computed tomography etc., in undiagnosed cases.

Methods: A total no of 129 patients with complaint of bleeding per rectum were included in the study. All cases were subjected to anoproctoscopy and rigid sigmoidoscopy. Colonoscopy was done in cases with severe or recurrent bleeding which were undiagnosed by sigmoidoscopy. If colonoscopy does not reveal the diagnosis upper GI scopy or computerized tomography (CT) angiography was done.

Results: At the end of evaluation of 129 cases with bleeding per rectum, the cause for bleeding identified in 101 cases (78.3%). 28 cases (21.7%) remain undiagnosed.

Conclusions: Large bowel endoscopy increases the diagnostic yield in patients with bleeding per rectum. Rigid sigmoidoscopy is a safe OPD based procedure, recommended in all patients presenting with bleeding per rectum and if the cause for bleeding per rectum cannot be diagnosed by rigid sigmoidoscopy, then colonoscopy is indicated. Even colonoscopy is not diagnostic, then the other investigations like upper GI scopy and CT angiography can be done to identify the source of bleeding.

References

Nelson RL, Abcarian H, Davis FG, Persky V. Prevalence of benign anorectal disease in a randomly selected population. Dis Colon Rectum. 1995;38:341-4.

Talley NJ, Jones M. Self-reported rectal bleeding in a United States community: prevalence, risk factors, and health care seeking. Am J Gastroenterol. 1998;93:2179-83.

Crosland A, Jones R. Rectal bleeding: prevalence and consultation behaviour. Bri Med J. 1995;311:486-8.

Johnson DA, Gurney MS, Volpe RJ, Jones DM, Van Ness MM, Chobanian SJ et al. A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an agerelated risk. Am J Gastroenterol. 1990;85(8):969-74.

Dehn T, McGinn FP. Causes of ano-rectal bleeding. Postgraduate Med J. 1982; 58:92-3.

PS Cheung, SK Wong, J Boey, CK Lai. Frank rectal bleeding: a prospective study of causes in patients over the age of 40. Postgraduate Med J. 1988;64:364-8.

Banothu Srinivas, B. Shailendra. The diagnostic efficiency of sigmoidoscopy in patients with bleeding per rectum. IAIM. 2016;3(6):164-9.

Nikpour S, Ali Asgari A. Colonoscopic evaluation of minimal rectal bleeding in average-risk patients for colorectal cancer. World J Gastroenterol. 2008;14(42):6536-40.

Jensen DM, Machicado GA. Diagnosis and treatment of severe hematochezia. The role of urgent colonoscopy after purge. Gastroenterol. 1988;95:1574-96.

Ettorre GC, Francioso G, Garribba AP, Fracella MR. Helical CT angiography in gastrointestinal bleeding of obscure origin. Am J roentgenol. 1997;168:727-31.

Dakubo JCB, Seshie B, Ankrah LAN. Utilisation and diagnostic yield of large bowel endoscopy at KorleBu Teaching Hospital. J Medical and Biomed Sci. 2014;3(1):6-13.

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Published

2020-10-23

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Section

Original Research Articles