Cause Of Rectal Bleeding Research Articles

Solitary rectal ulcer syndrome in a teenage patient, an unrecognized cause of rectal bleeding: A case report

Not available

A rare cause of rectal bleeding

A rare cause of rectal bleeding

Rectal bleeding in pregnant women

The article presents a review of scientific literature on the main causes of rectal bleeding in pregnant women. Anatomical, biochemical and hormonal changes during pregnancy often lead to the progression of typical benign diseases (chronic hemorrhoids, anal fissure, etc.), radical surgical treatment of which can be carried out in the puerperal period. However, Crohn’s disease, ulcerative colitis or malignant colorectal polyps can be triggered by pregnancy and affect its course – this requires immediate examination and drug therapy. Pregnancy causes many physiological changes that affect the interpretation of routine biochemical and hematological examination methods. It is known that pregnancy requires increased iron content, the pregnancy courses often with anemia. The erythrocytes sedimentation rate varies significantly depending on the severity of anemia and the pregnancy term. Therefore, it is necessary to carefully analyze the main clinical manifestations of various intraluminal diseases that can potentially cause rectal bleeding in pregnant women.This article also describes the directions of diagnostic search and treatment strategy of rectal bleeding during pregnancy. Chronic hemorrhoids often accompany pregnancy in the third trimester. Some researchers indicate that up to 75% of pregnant women have complaints which are typical for chronic hemorrhoids. An anal fissure in lateral positions should cause suspicion of Crohn’s disease, tuberculosis, syphilis, human immunodeficiency virus, acquired immunodeficiency syndrome, dermatological diseases (most often psoriasis) and anal carcinoma.Bleeding in sexually acquired proctitis is usually mild and is often accompanied by minor purulent discharge. Rectal bleeding can be a sign of both ulcerative colitis and Crohn’s proctitis or sigmoiditis, but it is more typical for ulcerative colitis. Other associated clinical features are diarrhea, abdominal pain, urge to defecate, and specific extraintestinal manifestations (peripheral arthropathy, sacroiliitis, ankylosing spondylitis, conjunctivitis, iridocyclitis, episcleritis, aphthous skin ulcers, erythema nodosum, or pyoderma gangrenosum). If the bleeding is caused by a benign polyp, endoscopic polypectomy solves the bleeding problem.Therefore, rectal bleeding in pregnant women is diagnosed quite often. In most cases, it is caused by benign diseases of the rectum (chronic hemorrhoids or anal fissure), which are amenable to conservative therapy and usually do not threaten the life and health of a woman or a child. However, there is a rate of pregnant women whose rectal bleeding is caused by colorectal diseases, which require a comprehensive approach to diagnosis and treatment. In these women, the benefit and risk should be determined when choosing a diagnostic and treatment algorithm.

Colonoscopic Findings in Patients with Bleeding Per-rectum in Colonoscopy Center at Rizgary Teaching Hospital, Erbil, Iraq

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.

The infant with rectal bleeding

Although rectal bleeding in infants is often minor, either as the result of swallowed maternal blood or anal fissure there is the potential for the patient to be significantly unwell and require urgent management. This article discusses common and rarer but not to be missed causes of rectal bleeding in infants and their immediate management. The aim is to provide a guide for the general paediatrician.

Solitary rectal ulcer syndrome – An uncommon cause of rectal bleeding in children

Background: Solitary rectal ulcer syndrome (SRUS) is a benign chronic disorder rarely found in children commonly presents with rectal bleeding, mucorrhea, straining during defecation, tenesmus, feeling of incomplete defecation, rectal prolapse and constipation. The pathogenesis is not clearly understood but several factors such as trauma, rectal prolapse, ischemia, behavioral disorders such as excessive straining during defecation and rectal manipulation, sexual abuse and disharmony of the pelvic floor muscles during defection may be involved. SRUS is diagnosed on the basis of clinical symptoms and endoscopic and histological findings. Various treatment protocol for SRUS have been described such as conservative management such as family reassurance, regulation of toilet habits, avoidance of straining, encouragement of a high-fiber diet, topical treatments with salicylate, sulfasalazine, steroids and sucralfate, and surgery. Methods: A comprehensive search is done using PubMed, Scopus, Google scholar and MEDLINE. Results: The result of this review will be published in a journal. Conclusion: This study discusses about the pathogenesis, clinical features, diagnosis and various treatment strategy of solitary rectal ulcer syndrome in children. Bangladesh Medical Res Counc Bull 2023; 49(1): 70-74

Creating a Safety Net Process to Improve Colon Cancer Diagnosis in Patients With Rectal Bleeding.

Background Failure to follow up on patients with rectal bleeding is common and may result in a delay in diagnosis of colorectal cancer or in missing high-risk adenomas. The authors' purpose was to create an electronic patient safety net for those diagnosed with rectal bleeding but who did not have colonoscopy to ensure proper detection of colonic abnormalities, including colon cancer. Methods In an integrated health delivery system serving < 4.6 million patients in Southern California, from 2014 to 2019, the authors electronically identified patients with rectal bleeding aged 45 to 80 years but with no recently documented colonoscopy. These cases were reviewed by a gastroenterologist to determine if colonoscopy was appropriate. The physician looked for known documentation as to the cause of rectal bleeding and verified no contraindications to the procedure; if indicated, testing was offered. Results Using the authors' safety net program, 1430 patients with rectal bleeding who needed and completed a colonoscopy were identified. Of those patients, 7.5% had an advanced adenoma or cancer, with a total of 20 cancers, and 34% had findings that warranted more frequent colonoscopy. Conclusions The authors designed a safety net system that was able to capture information on patients with rectal bleeding who had not had a colonoscopy and detected in 34% colonic pathology that would have otherwise gone undetected. The program did not require many resources to implement and had the ability to potentially prevent harm from reaching patients whose rectal bleeding did not get prompt workup. Other health systems and practices should consider implementing a similar system.

An Unusual Case of Rectal Bleed in an Section Adolescent: Solitary Rectal Ulcer Syndrome Mimicking Rectosigmoid Malignancy

Solitary Rectal Ulcer Syndrome (SRUS) is an uncommon rectal disorder. Severe rectal bleeding, anaemia and a mass on evaluation are a rare presentation of SRUS, and can pose as an endoscopic challenge in differentiating from other causes of rectal bleeding. The incidence of SRUS is 1 in 100,000 people per year. Hence, a high degree of suspicion and timely diagnosis is necessary. The present case case is about a 17-year-old female who presented with rectal bleeding. Physical evaluation revealed a large polypoidal rectal mass mimicking malignancy which later turned out to be SRUS. The patient improved with medical management. On outpatient follow-up, she had no complaints after a month and follow-up lower endoscopy and imaging later revealed complete healing within three months. Although uncommon, SRUS should be considered as a potential cause of lower gastrointestinal bleeding after sinister causes have been ruled out.

Evaluation and management of rectal bleeding in pregnancy.

Rectal bleeding occurs in about 40% of pregnant women, and is predominantly attributed to benign perianal pathology (haemorrhoids or anal fissures). More sinister causes of rectal bleeding may be heralded by key red flag clinical and biochemical features. These features should be evaluated in all women with rectal bleeding. Imaging investigations or flexible sigmoidoscopy may be warranted. The latter can be performed safely by experienced operators in pregnant women. Women with evidence of haemodynamic compromise, elevated inflammatory markers, significant anaemia, signs of intestinal obstruction or compromise to the fetus should be evaluated urgently. Providers must be mindful of the changes in normal ranges for common haematological and biochemical parameters in pregnancy compared with the non-pregnant state. Faecal calprotectin is an established tool for identification of intestinal inflammation and is valid in pregnancy. An elevated faecal calprotectin level (≥50µg/g) signifies a need for further diagnostic evaluation. Inflammatory bowel disease may present initially, or with worsening disease activity, in pregnancy. Expedient diagnosis with the use of faecal calprotectin, sigmoidoscopy with or without intestinal ultrasound, exclusion of alternative or compounding infective aetiologies, and institution of appropriate therapy are critical. Medical therapies for management of inflammatory bowel disease can be safely instituted in pregnancy. Colorectal cancer incidence is increasing in younger age groups, but fortunately remains rare. When diagnosed in pregnancy, colorectal cancer can be successfully and safely managed with a collaborative multidisciplinary team approach. Early diagnosis is key to optimising outcomes.

S1935 Anorectal Melanoma: A Rare but Potentially Fatal Cause of Rectal Bleeding

Introduction: Rectal bleeding is a common complaint with many relatively benign causes including hemorrhoids, anal fissures, and colonic diverticula. However, there are more insidious causes of rectal bleeding that can potentially prove to be fatal without early intervention, including colon cancer. Here, we present one rare but potentially deadly cause of rectal bleeding. Case description/methods: A 63-year-old female presents with 1 month history of recurrent painless hematochezia. Prior to presentation, she had 3 episodes large volume bright red blood per rectum. Screening colonoscopy completed 3 years earlier was negative. On presentation the patient was hemodynamically stable, but severely anemic with hemoglobin of 6 g/dl. Digital rectal exam revealed a large anterior anal mass. Further evaluation with colonoscopy revealed a bleeding 2 cm submucosal mass in the anal canal, extending distal to the dentate line, which bled easily with pressure and fibrovascular in appearance. The mass was too friable to biopsy at the time of colonoscopy. She underwent trans-anal resection of the anal mass. Histopathology revealed nodular mucosal malignant melanoma, epithelioid type. Immunohistochemical studies were positive for SOX-10 and Melan A, and negative for cytokeratin AE, CD45, chromogranin, synaptophysin, BRAF. Whole-body PET scan revealed 1.1 cm perirectal lymph node involvement without evidence of distant metastasis. Follow up MRI revealed six suspicious meso-rectal lymph nodes. Eventually, the patient underwent abdominoperineal resection (APR). Histopathology following APR revealed 3 tumor deposits, with negative surgical margin, 7/16 lymph nodes involvement. Patient is following oncology for adjuvant chemotherapy. Discussion: Anorectal melanoma (ARM) is rare, having fewer than 700 cases reported in the literature. Patients with anorectal melanoma typically present with rectal bleeding, anorectal pain, and change in bowel habits. The gold standard for diagnosis is immunohistochemistry. Treatment strategies include surgery with or without immunotherapy. Unfortunately, recurrence and mortality rate are high, with a 5-year survival rate of less than 20% and a median survival of less than 2 years. In summary, ARM is a rare and aggressive variant of mucosal melanoma which is often associated with diagnosis at advanced stage, high metastatic potential, and high mortality. It is imperative that a high index of suspicion be maintained to mitigate the high burden of late diagnoses and advanced disease.Figure 1.: Figure 1A. 4.3 x 3.5 cm mass anterior to a large sigmoid diverticulum with Hounsfield units of 22-36 (red arrow). Hounsfield units of lipomas range from 30 to 70. Figure 1B. 4 cm pedunculated polyp 20 cm from the anal verge. Figure 1C. Microscopy depicting submucosal mass with mature white adipose tissue (red arrow).

Granulomatous Variant of Food Protein-Induced Allergic Proctocolitis.

A 7-month-old infant on commercial cow milk formula presented with a 4-week history of bloody stools without vomiting, diarrhea, fever, or skin rash. The patient did not appear ill, had a normal physical examination, and took his feeds well. Laboratory results showed a leukocyte count of 17,400/mm3 (reference range, 4400–19,100/mm3) with 12% eosinophils (0.0%–5.0%), hemoglobin level of 12.7 g/dL (10.1–14.2 g/dL), and albumin level of 4.3 g/dL (3.2–4.8. g/dL). Stool cultures were unremarkable. A stool smear showed a large number of eosinophils. Serum IgE, IgG, IgM, and IgA levels were unremarkable, and radioallergosorbent test, performed to determine the presence of specific IgE against cow milk, α-lactalbumin, or casein were all negative. Rectosigmoidoscopy revealed patchy erythema with congestion of the rectal and sigmoid colon mucosa (Fig. 1). Biopsy specimens revealed numerous eosinophils and degranulation in the mucosa (Fig. 2), and notably, granulomatous infiltrates composed of multinucleate giant cells with prominent eosinophils and degranulation in the submucosa (Fig. 3).FIGURE 1.: Rectosigmoidoscopy results showing patchy erythema with congestion of the mucosa in the rectum and sigmoid colon.FIGURE 2.: Biopsy specimens showing numerous eosinophils and degranulation in the mucosa of the sigmoid colon (hematoxylin and eosin staining; original magnification, 200X).FIGURE 3.: Biopsy specimens showing granulomatous infiltrates composed of multinucleate giant cells with prominent eosinophils and degranulation in the submucosa of the sigmoid colon (arrow: multinucleate giant cell, hematoxylin and eosin staining; original magnification, 200X).Immunodeficiency was considered, but history of unusual, severe, or recurrent infections was negative, and serum immunoglobulin levels were normal. Although presentation with granulomas is atypical, the patient was diagnosed with food protein-induced allergic proctocolitis (FPIAP) based on the clinical and histological findings. The commercial cow milk formula was replaced with an extensively hydrolyzed formula, resulting in a dramatic improvement in the condition of the patient. The patient has remained on an extensively hydrolyzed formula and has been consuming a variety of solid foods. No relapse of symptoms has been observed, 5 months after the diagnosis. FPIAP is a common cause of rectal bleeding in an otherwise healthy young infant (1). In most cases of FPIAP, biopsy specimens show prominent eosinophilic infiltration of the rectosigmoid mucosa (2,3). Occurrence of a granulomatous component, as seen in this patient, is a distinctly rare phenomenon in this disease. To date, only two studies have shown the presence of granulomas in FPIAP (4,5). The presence of a granulomatous infiltrate may indicate a severe form of FPIAP (4). Generally, the prognosis of FPIAP is favorable, and tolerance is acquired by around the 1-year of age (6,7). The presence of granulomas in FPIAP should not lead to a diagnosis of any other disease that presents with granulomas based on histological findings, such as early-onset inflammatory bowel disease, primary immunodeficiency, or various infectious diseases (8). Awareness of such unusual and misleading features in FPIAP is, therefore, necessary to avoid unfortunate misdiagnosis as another disease. ACKNOWLEDGMENTS We would like to thank Editage (www.editage.com) for English language editing.

Solitary Rectal Ulcer Syndrome in Children

To describe clinical features, demographic data, and complications of the patients with SRUS, which is a rare cause of rectal bleeding in children. Eleven patients diagnosed with Solitary Rectal Ulcer Syndrome (SRUS) were evaluated. The patients assessed by colonoscopy and the biopsies were investigated. The data evaluated in SPSS Program. The exact Method of the Chi-square test was used to compare groups according to qualitative variables. P &lt;0.05 value was considered statistically significant. The most common symptom of the patients was rectal bleeding followed by abdominal pain and constipation. Lesions were mostly ulcerative in the endoscopic examination. There was a statistically significant relationship between the admission symptom and the response to treatment. Patients with abdominal pain and rectal bleeding had poor responses to treatment. In conclusion, SRUS is not uncommon than is thought in pediatric patients with the symptoms of rectal bleeding and constipation. SRUS should be considered in patients with or without rectal prolapse, with any complaints of any lesions in the rectum, hematochezia, and tenesmus.

English

BACKGROUND Haemorrhoids are one of the most common anorectal conditions encountered in clinical practice and are recognised as a common cause of rectal bleeding, perianal itching and anal discomfort. Therapeutic treatment of haemorrhoids needs to be tailored according to grades and complication of haemorrhoids, patient preference and expertise of procedure. Very limited data is available regarding effectiveness of retrograde endoscopic injection sclerotherapy for the management of bleeding haemorrhoids. We wanted to study the effectiveness of retrograde endoscopic sclerotherapy (REST) for the management of various grades of bleeding internal haemorrhoids. METHODS A prospective study, included 87 patients with Gr. I, II and Gr. III symptomatic bleeding internal haemorrhoids. They were subjected to retrograde endoscopic sclerotherapy using Inj. Polidocanol to study its effectiveness in controlling bleeding. Effectiveness of the procedure was defined by stoppage of bleeding at 3 months follow up. RESULTS Bleeding stopped in 95.3 % cases after retrograde endoscopic sclerotherapy at 3 months follow up. No significant complications were observed with the procedure during the study period. CONCLUSIONS Retrograde endoscopic sclerotherapy is a safe, well tolerated and effective modality for the management of bleeding internal haemorrhoids. KEYWORDS Haemorrhoids, Retrograde Endoscopic Sclerotherapy

S1774 Primary Anorectal Malignant Melanoma: Rare and Fatal

INTRODUCTION: We present an uncommon diagnosis of primary anorectal malignant melanoma (ARMM) in a patient with anemia and altered bowel habits. Primary ARMM accounts for less than 4% of anorectal malignancies and less than 1.5% of all melanomas. ARMM can often go undiagnosed, which is detrimental to patients due to its aggressive nature. CASE DESCRIPTION/METHODS: 63 y.o. African American male with a history of ascending colon resection for colon adenocarcinoma 8 years prior was referred for change in bowel habits and nausea with eating. He had worsening intermittent constipation, but denied melena or blood in his stool. He had nausea 45 minutes after eating but no vomiting. He denied recent weight loss. His last colonoscopy was a year after colon resection. The ileocolonic anastomosis was at 70 cm from anal verge, there was a 3 mm hyperplastic polyp in the sigmoid and repeat colonoscopy was recommended in a year. Physical exam was negative for skin hyperpigmentation, moles or lesions. Abdominal exam was negative for tenderness, guarding or rebound. Labs showed normocytic anemia, Hgb 8.1 g/dl from 12 g/dl the year prior. Digital rectal exam revealed a firm immobile mass, 3 cm from anal verge. Colonoscopy showed a fungating, ulcerated, non-obstructing 3 cm mass in the rectum. Biopsies were done with cold forceps for histology. Pathology noted the mass had brownish pigmentation and extensive necrosis, consistent with malignant melanoma. Immunohistochemical staining was positive for S-100, HMB-45, Melan-A and SOX-10 supporting the diagnosis. A diagnosis of primary anorectal malignant melanoma was made as patient had no evidence of cutaneous or ocular melanoma. PET scan showed metastasis to a large pelvic lymph node so patient was not a surgical candidate. Oncology started patient on immunotherapy with ipilmumab and nivolumab. DISCUSSION: Primary ARMM is a rare malignancy, especially in African Americans such as our patient, with a poor prognosis. As with our case, presenting symptoms can be unspecific such as anemia. Often patients with ARMM present with rectal bleeding that is attributed to hemorrhoids and endoscopic intervention is not pursued. This is detrimental as it causes a delay in diagnosis. Our patient’s mass was pigmented, but in 29% of cases the mass may be amelanotic resulting in misdiagnosis. Treatment is abdominoperineal resection if there is no evidence of metastasis. Our case highlights the importance of recognizing primary ARMM as a cause of rectal bleeding in patients with an anorectal mass.Figure 1.: Retroflexed view in the rectum revealing the pigmented, ulcerated, non-obstructing 3 cm mass at 3 cm from anal verge.Figure 2.: The mass is composed of melanoma cells that formed irregular nests and cords, and manifested enlarged and hyperchromatic nuclei with irregular nuclear contours and prominent nucleoli. The pigments were finely granular and brownish. (H&E, x200).Figure 3.: Immunohistochemistry demonstrated the tumor cells to be positive for S-100 (Fig. A, cytoplasmic stain, fast red; X100), HMB-45 (Fig. B, cytoplasmic stain, fast red; X100) and SOX-10 (Fig. D, nuclear stain, fast red; X100). They were negative for expression of pan-cytokeratin, the brown granules in the background are melanin pigments (Fig.C, AE1/3, lack of cytoplasmic stain, DAB; X100).

Allerjik Proktokolit Öngörüsünde Hematolojik Parametrelerin Kullanımı

Aim: Allergic proctocolitis (AP) is a common cause of rectal bleeding in infants. There is no diagnostic tool specific to the disease. The aim of the study was to evaluate hemogram parameters as a marker of inflammation in patients with AP.Material and Methods: The files of patients who were exclusively breastfed and diagnosed as food protein induced AP were examined retrospectively. A hundred and fifty patients diagnosed with AP were included in the study. The same number of healthy babies formed the control group. Parameters in complete blood count were compared between patient and control groups. Rectosigmoidoscopic examination was performed to confirm the diagnosis in patients who could not achieve complete improvement with diet therapy, and hemogram parameters were evaluated according to eosinophilic infiltration in biopsies.Results: The mean platelet volume (MPV) values (p&amp;lt;0.001) and eosinophil percentages (p=0.001) of the AP group were higher than the control group. The mean hemoglobin values of the AP group were statistically significantly lower than the control group (p&amp;lt;0.001). No statistically significant difference was found between patient and control groups in terms of white blood cell (WBC) count, platelet count, platelet distribution width (PDW) and neutrophil/lymphocyte ratio (NLR). WBC count, platelet count, hemoglobin, MPV and C-reactive protein (CRP) values were similar between groups of patients according to the number of eosinophils in colon biopsies.Conclusion: We observed a significantly higher MPV values and eosinophil percentages in patients with AP. These parameters maybe helpful in diagnosis of AP.

Use of colour Doppler to eliminate rectal bleeding from trans-rectal ultrasound-guided biopsy of the prostate

Bleeding is one of the complications of trans-rectal ultrasound (TRUS)-guided biopsy of the prostate. Urethral bleeding could be prevented by avoiding the trajectory on the urethra. However, rectal bleeding is difficult to predict because the peri-prostatic, intra-prostatic and rectal vessels cannot be seen on an ordinary ultrasound scan. Use of colour Doppler to map out the vessels cognitively before injection of local anaesthesia prevents puncture of the vessels, which is a key cause of rectal bleeding. Level of evidence: Not applicable.

Foreign body perforation of a jejunal diverticulum: a rare cause of rectal bleeding.

ANZ Journal of SurgeryVolume 91, Issue 3 p. 465-467 IMAGES FOR SURGEONS Foreign body perforation of a jejunal diverticulum: a rare cause of rectal bleeding Yeqian Huang BMed, MD, Yeqian Huang BMed, MD orcid.org/0000-0001-5416-1246 Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia South Western Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, AustraliaSearch for more papers by this authorMina Sarofim BMed, MD, MS, Mina Sarofim BMed, MD, MS orcid.org/0000-0003-3808-0774 Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia South Western Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, AustraliaSearch for more papers by this authorRuben Cohen-Hallaleh BSc (Med), MBBS, ChM, FRACS, Ruben Cohen-Hallaleh BSc (Med), MBBS, ChM, FRACS orcid.org/0000-0003-2488-3015 Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia South Western Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, AustraliaSearch for more papers by this author Yeqian Huang BMed, MD, Yeqian Huang BMed, MD orcid.org/0000-0001-5416-1246 Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia South Western Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, AustraliaSearch for more papers by this authorMina Sarofim BMed, MD, MS, Mina Sarofim BMed, MD, MS orcid.org/0000-0003-3808-0774 Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia South Western Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, AustraliaSearch for more papers by this authorRuben Cohen-Hallaleh BSc (Med), MBBS, ChM, FRACS, Ruben Cohen-Hallaleh BSc (Med), MBBS, ChM, FRACS orcid.org/0000-0003-2488-3015 Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia South Western Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, AustraliaSearch for more papers by this author First published: 15 July 2020 https://doi.org/10.1111/ans.16170Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume91, Issue3March 2021Pages 465-467 RelatedInformation

Rectal tonsil: a rare cause of rectal bleeding.

Rectal tonsil: a rare cause of rectal bleeding.

Diagnostic Evaluation of Patients Presenting with Rectal Bleeding by Colonoscopy

Introduction: Rectal bleeding indicates the bleeding from lower gastro-intestinal tract occurring distal to ligaments of Treitz. Annual incidence of per rectal bleeding has been estimated to be 20% . Colonoscopy is the examination of choice for investigation. The objective of this study is to know the diagnostic yield of colonoscopy in cases with per rectal bleeding and to know the common causes of per rectal bleeding in adults. Methods: One hundred and twenty-nine adult patients, age more than 18years, who presented to Surgical OPD and ward of Dhulikhel Hospital during the year 2018 and 2019 were taken for the study irrespective of their sex. All the patients were subjected to fibre-optic colonoscopy after necessary preparation and the findings were recorded. Diagnosis was based on colonoscopic and histopathologic findings. Results: A total of 129 (77 male and 52 female) patients with per rectal bleeding were evaluated with colonoscopy. The age ranged from 18 years to 79 years with the mean age 42.25 (SD+/- 15.29). Colonoscopy showed abnormalities in 102 patients (79.06%). The most common finding was hemorrhoids in 36 patients (27.90%) followed by colorectal malignant mass in 20 patients (15.50%). Polyps were diagnosed as the cause of rectal bleeding in 14 patients (10.84%). Conclusion: Colonoscopy has good diagnostic yield at evaluating cases with per rectal bleeding. Hemorrhoids, colorectal malignant mass and polyps are the common causes producing PR bleeding in Nepalese adult population.

Diagnostic Evaluation of Patients Presenting with Rectal Bleeding by Colonoscopy

Introduction Rectal bleeding indicates the bleeding from lower gastro-intestinal tract occurring distal to ligaments of Treitz. Annual incidence of per rectal bleeding has been estimated to be 20% . Colonoscopy is the examination of choice for investigation. The objective of this study is to know the diagnostic yield of colonoscopy in cases with per rectal bleeding and to know the common causes of per rectal bleeding in adults&#x0D; MethodsOne hundred and twenty-nine adult patients, age more than 18years, who presented to Surgical OPD and ward of Dhulikhel Hospital during the year 2018 and 2019 were taken for the study irrespective of their sex. All the patients were subjected to fibre-optic colonoscopy after necessary preparation and the findings were recorded. Diagnosis was based on colonoscopic and histopathologic findings.&#x0D; ResultsA total of 129 (77 male and 52 female )patients with per rectal bleeding were evaluated with colonoscopy. The age ranged from 18 years to 79 years with the mean age 42.25 (SD+/- 15.29). Colonoscopy showed abnormalities in 102 patients (79.06%). The most common finding was hemorrhoids in 36 patients (27.90%) followed by colorectal malignant mass in 20 patients (15.50%). Polyps were diagnosed as the cause of rectal bleeding in 14 patients (10.84%).&#x0D; ConclusionColonoscopy has good diagnostic yield at evaluating cases with per rectal bleeding. Hemorrhoids, colorectal malignant mass and polyps are the common causes producing PR bleeding in Nepalese adult population.