Abstract
Background and Study Aims: Hematochezia is a common clinical problem. When the bleeding is brisk and continuous
it requires prompt hospital admission and careful diagnostic evaluation and management.
Colonoscopy has become the first-line investigative modality in patients presenting
with severe hematochezia in many centers, including ours. A retrospective review was
carried out to evaluate the effectiveness of colonoscopy in determining the cause
of severe hematochezia in our Oriental population.
Patients and Methods: One hundred and ninety patients with severe hematochezia underwent colonoscopy at
the National University Hospital, Singapore, from 1 January 1988 to 31 December 1994.
Their records were retrieved and the data analyzed for sex, age, presentation, concomitant
medical conditions, prevalence of recent non-steroidal anti-inflammatory drugs ingestion,
past history of hematochezia, investigations, subsequent interventions and outcome.
Results: Colonoscopy as the fist-line investigative modality identified the site and cause
of hematochezia in 78 % (148/190) of cases. The site of bleeding remained “obscure”
even after additional investigations in 15 % (29/190) of cases. The commonest cause
of severe hematochezia in our Oriental population was diverticular disease (30 %,
57/190) with right-sided diverticular bleeding constituting 44 % (25/57) of these
cases. Overall, bleeding stopped spontaneously in 81 % (154/190) of cases. Surgery
was performed in 16 % (30/190) of cases. The mortality related to severe hematochezia
in this series was 5 % (9/190).
Conclusions: The diagnostic efficiency of colonoscopy in defining the site and cause of severe
hematochezia in the Oriental population is comparable to most Western series. The
commonest cause of severe hematochezia in our population was diverticular disease.
