Contribution of colonoscopy in the etiological diagnosis of rectal bleeding: About 139 cases

Aims The emission of blood through the rectum is most often due to benign anorectal causes, but the fear is to miss a tumor. The aim of our work is to underline the interest of colonoscopy in the etiological diagnosis of rectal bleeding with an acute or chronic presentation.

Methods We conducted a retrospective study over a period of 2 years (October 2020 – October 2022) where we collected 139 cases. All patients underwent a blood test and a colonoscopy.

Results The average age was 55.4 years (range: 19-96), a male predominance was noted (81 men against 58 women) with a sex ratio M/F=1,4. Rectal bleeding was isolated in 54 cases (38.8%) and associated with deterioration in general condition in 16 cases (11.5%), abdominal pain in 13 cases (9.3%), terminal constipation in 55 cases (39.5%) and alternating diarrhea-constipation in 11 cases (7.9%). Blood count (CBC) was made in all patients with rectal bleeding and objectified anemia in 22% of cases. Colonoscopy was normal in 30 cases (21.5%) and when it was pathological it showed: a rectal tumor process in 20 cases (14.3%), colonic neoplasia in 7 cases (5%). Among the 27 patients with colorectal neoplasia, 21 were over 50 years old and 6 patients (22%) were under 50 years old. Recto-colic polyps were observed in 14 cases (10%), a Colonic diverticulosis in 10 cases (7%), colonic angiodysplasia lesions in 6 cases (4.3%), colitis in 14 cases (10%), hemorrhoids in 46 cases (33%), and a solitary rectal ulcer in 3 cases (2%).

Conclusions Hemorrhoidal pathology is the most frequent etiology of rectal bleeding but it nevertheless remains a diagnosis of exclusion after elimination of other causes, in particular rectocolic neoplasia, hence the interest of a total colonoscopy even in the presence of hemorrhoids.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

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Artikel online veröffentlicht:
14. April 2023