Colonoscopic Findings in Patients with Bleeding Per-rectum in Colonoscopy Center at Rizgary Teaching Hospital, Erbil, Iraq | ||
| Al- Anbar Medical Journal | ||
| Articles in Press, Accepted Manuscript, Available Online from 18 April 2023 PDF (411.77 K) | ||
| Document Type: Original articles | ||
| DOI: 10.33091/amj.2023.178354 | ||
| Authors | ||
| Mahmood Saud F. Khudhur* ; Ali Al Dabbagh | ||
| Department of Surgery/General Surgery, Rizgary Teaching Hospital, Erbil, Iraq. | ||
| Abstract | ||
| Background: Rectal bleeding is commonly seen in daily practice. The colonoscopy is an essential diagnostic tool in detecting the various causes of this clinical entity. Objectives: We aimed to detect the different pathological lesions in patients with rectal bleeding using colonoscopy and to find the correlation between colonoscopic findings and the age and gender of the patients. Materials and Methods: This prospective cross-sectional study was conducted at the center of endoscopy and colonoscopy at Rizgary Teaching Hospital throughout the period from April 2018 to April 2019. Patients with bleeding from the rectum and subjected to colonoscopy of any age and gender were enrolled in the current study. Data regarding the age, gender, duration, family history of colorectal cancer, whether the bleeding was fresh or mixed with stool, spontaneous stoppage of bleeding or not, and the colonoscopic findings were recorded for every participant. Results: Of 91 patients with rectal bleeding, there were 55 (60.4%) male. The most affected age group was over 40 years old (n = 47, 51.6%). Only 11 (12.1%) of the participants gave a family history of colorectal cancer. Around three-quarters of the cases involved chronic bleeding. The bleeding was fresh in 60 (65.9%) cases. The majority of the bleeding (n = 74, 81.3%) stopped spontaneously. Hemorrhoids (49.45%) were the most common colonoscopic finding in patients with rectal bleeding, followed by no abnormality (18.68%), and the least diverticular disease (2.2%). There was a statistically significant difference between the age of the patient and the cause of rectal bleeding (P-value = 0.042). However, there was no such correlation regarding the patient's gender (P-value = 0.196). Conclusion: Hemorrhoids were the most common colonoscopic finding in patients with rectal bleeding. The age of the patient can determine the cause of the rectal bleeding. | ||
| Keywords | ||
| Colonoscopy; Colonoscopic findings; Lower gastrointestinal tract; Bleeding per Rectum; Lower gastrointestinal bleeding | ||
| References | ||
|
[1] S. A. Xavier, F. J. Machado, J. T. Magalhães, and J. B. Cotter, “Acute lower gastrointestinal bleeding: are STRATE and BLEED scores valid in clinical practice?,” Color. Dis., vol. 21, no. 3, pp. 357–364, 2019.
[2] L. Hermie, E. Dhondt, P. Vanlangenhove, J. De Waele, H. Degroote, and L. Defreyne, “Empiric cone-beam CT-guided embolization in acute lower gastrointestinal bleeding,” Eur. Radiol., vol. 31, no. 4, pp. 2161–2172, 2021.
[3] C. Prakash and G. R. Zuckerman, “Acute small bowel bleeding: a distinct entity with significantly different economic implications compared with GI bleeding from other locations,” Gastrointest. Endosc., vol. 58, no. 3, pp. 330–335, 2003.
[4] K. Triantafyllou et al., “Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline,” Endoscopy, vol. 53, no. 08, pp. 850–868, 2021.
[5] M. Di Serafino et al., “The Role of CT-Angiography in the Acute Gastrointestinal Bleeding: A Pictorial Essay of Active and Obscure Findings,” Tomography, vol. 8, no. 5, pp. 2369–2402, 2022.
[6] T. Adegboyega and D. Rivadeneira, “Lower GI bleeding: an update on incidences and causes,” Clin. Colon Rectal Surg., vol. 33, no. 01, pp. 28–34, 2020.
[7] K. Oakland et al., “Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology,” Gut, vol. 68, no. 5, pp. 776–789, 2019.
[8] N. Jagtap, D. N. Reddy, and M. Tandan, “Lower Gastrointestinal Bleeding,” J. Dig. Endosc., vol. 13, no. 01, pp. 14–18, 2022.
[9] T. Aoki, Y. Hirata, A. Yamada, and K. Koike, “Initial management for acute lower gastrointestinal bleeding,” World J. Gastroenterol., vol. 25, no. 1, p. 69, 2019.
[10] Y. Bai, J. Peng, J. Gao, D. Zou, and Z. Li, “Epidemiology of lower gastrointestinal bleeding in China: Single‐center series and systematic analysis of Chinese literature with 53 951 patients,” J. Gastroenterol. Hepatol., vol. 26, no. 4, pp. 678–682, 2011.
[11] R. Niikura et al., “Factors affecting in-hospital mortality in patients with lower gastrointestinal tract bleeding: a retrospective study using a national database in Japan,” J. Gastroenterol., vol. 50, no. 5, pp. 533–540, 2015.
[12] N. Tapaskar, B. Jones, S. Mei, and N. Sengupta, “Comparison of clinical prediction tools and identification of risk factors for adverse outcomes in acute lower GI bleeding,” Gastrointest. Endosc., vol. 89, no. 5, pp. 1005–1013, 2019.
[13] N. A. Ali, H. M. Sobih, N. M. Emara, A. M. Ziedan, and I. E. Ibrahim, “Clinical and Pathological Study of the Rectal Mucosa in Cases of Bleeding Per Rectum,” Benha J. Appl. Sci., vol. 6, no. 4, pp. 57–63, 2021.
[14] R. Niikura et al., “Efficacy and safety of early vs elective colonoscopy for acute lower gastrointestinal bleeding,” Gastroenterology, vol. 158, no. 1, pp. 168–175, 2020.
[15] M. M. Yousif, M. A. Ashour, F. O. Selim, and M. A. Hasan, “Colonoscopic Findings among Patients with Lower Gastrointestinal Tract Bleeding Admitted to Intensive Care Unit,” Egypt. J. Hosp. Med., vol. 87, no. 1, pp. 1497–1500, 2022.
[16] J. J. Farrell and L. S. Friedman, “the management of lower gastrointestinal bleeding,” Aliment. Pharmacol. Ther., vol. 21, no. 11, pp. 1281–1298, 2005.
[17] G. Zuccaro Jr, “Management of the adult patient with acute lower gastrointestinal bleeding,” Off. J. Am. Coll. Gastroenterol. ACG, vol. 93, no. 8, pp. 1202–1208, 1998.
[18] S. J. Boley, A. DiBiase, L. J. Brandt, and R. J. Sammartano, “Lower intestinal bleeding in the elderly,” Am. J. Surg., vol. 137, no. 1, pp. 57–64, 1979.
[19] K. D. Vellacott, “Early endoscopy for acute lower gastrointestinal haemorrhage.,” Ann. R. Coll. Surg. Engl., vol. 68, no. 5, p. 243, 1986.
[20] A. R. Al Qahtani, R. Satin, J. Stern, and P. H. Gordon, “Investigative modalities for massive lower gastrointestinal bleeding,” World J. Surg., vol. 26, no. 5, pp. 620–625, 2002.
[21] L. L. Strate and S. Syngal, “Timing of colonoscopy: impact on length of hospital stay in patients with acute lower intestinal bleeding,” Am. J. Gastroenterol., vol. 98, no. 2, pp. 317–322, 2003.
[22] D. M. Jensen and G. A. Machicado, “Diagnosis and treatment of severe hematochezia: the role of urgent colonoscopy after purge,” Gastroenterology, vol. 95, no. 6, pp. 1569–1574, 1988.
[23] D. M. Jensen, G. A. Machicado, R. Jutabha, and T. O. G. Kovacs, “Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage,” N. Engl. J. Med., vol. 342, no. 2, pp. 78–82, 2000.
[24] G. A. Smith and P. O’dwyer, “Sensitivity of double contrast barium enema and colonoscopy for the detection of colorectal neoplasms,” Surg. Endosc., vol. 15, no. 7, pp. 649–652, 2001.
[25] E. J. Irvine et al., “Prospective comparison of double contrast barium enema plus flexible sigmoidoscopy v colonoscopy in rectal bleeding: barium enema v colonoscopy in rectal bleeding.,” Gut, vol. 29, no. 9, pp. 1188–1193, 1988.
[26] T. Ohyama, Y. Sakurai, M. Ito, K. Daito, S. Sezai, and Y. Sato, “Analysis of urgent colonoscopy for lower gastrointestinal tract bleeding,” Digestion, vol. 61, no. 3, pp. 189–192, 2000.
[27] D. K. Bhargava, R. R. Rai, S. Dasarathy, and P. Chopra, “Colonoscopy for unexplained lower gastrointestinal bleeding in a tropical country.,” Trop. Gastroenterol. Off. J. Dig. Dis. Found., vol. 16, no. 1, pp. 59–63, 1995.
[28] K. Goulston, I. Cook, O. Dent, S. A. W. T. H. E. C. HOSPITAL, and G. UNIT, “How important is rectal bleeding in the diagnosis of bowel cancer and polyps?,” Lancet, vol. 328, no. 8501, pp. 261–265, 1986.
[29] N. Zia, T. Hussain, A. Salamat, S. Mirza, F. Hassan, and A. Waqar, “Diagnostic evaluation of patients presenting with bleeding per rectum by colonoscopy,” J Ayub Med Coll Abbottabad, vol. 20, no. 1, pp. 73–76, 2008.
[30] J. A. Acosta, T. K. Fournier, C. O. Knutson, and J. J. Ragland, “Colonoscopic evaluation of rectal bleeding in young adults.,” Am. Surg., vol. 60, no. 11, pp. 903–906, 1994.
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