Document Detail

Is full colonoscopic examination necessary in young patients with fresh bleeding per rectum?
MedLine Citation:
PMID:  21448853     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND STUDY AIMS: Guidelines and practices differ regarding evaluation of young patients with fresh bleeding per rectum (FBPR). The aim of this study was to determine the frequency and site of endoscopic lesions in young patients with FBPR, and to thereby determine whether full colonoscopic examination is necessary in these patients.
METHODS: Consecutive patients aged 18-50 years who were scheduled to undergo full colonoscopy for FBPR at Aga Khan University Hospital between May 2007 and October 2009 were enrolled in the study after giving informed consent. FBPR was defined as the passing of fresh blood per rectum with or without stools and/or noticing blood in the toilet bowl. Lesions were characterized as proximal or distal to the splenic flexure. Patients with positive family history of colorectal cancer, bleeding requiring blood transfusion, bleeding diathesis, or iron deficiency anemia were excluded.
RESULTS: A total of 379 patients met the inclusion criteria and were analyzed. Of these, 248 patients (65.4%) were under 40 years of age and 131 (34.6%) were aged 40-50 years. Mean hemoglobin was 12.93 ± 1.78 g/dL. In patients < 40 years, seven (2.8%) adenomatous polyps and malignant lesions were found, all of which were located in the distal colon. In patients aged 40-50 years, 10 (7.6%) adenomatous polyps and malignant lesions were detected, one of which was located in the proximal colon. On univariate analysis, malignant and adenomatous lesions were significant in the 40-50 years age group (P = 0.031; OR, 2.84; 95% CI 1.05-7.65).
CONCLUSION: Endoscopic lesions in patients younger than 40 years with FBPR are found mostly in the distal colon and hence flexible sigmoidoscopy seems to be a reasonable evaluation tool in young patients with no other alarm symptoms.
A B Khalid; S Majid; M Salih; F Hashmat; W Jafri
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Publication Detail:
Type:  Journal Article     Date:  2011-03-29
Journal Detail:
Title:  Endoscopy     Volume:  43     ISSN:  1438-8812     ISO Abbreviation:  Endoscopy     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-08-03     Completed Date:  2012-01-10     Revised Date:  2012-02-28    
Medline Journal Info:
Nlm Unique ID:  0215166     Medline TA:  Endoscopy     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  692-6     Citation Subset:  IM    
Copyright Information:
© Georg Thieme Verlag KG Stuttgart · New York.
Section of Gastroenterology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
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MeSH Terms
Adenocarcinoma / complications*,  diagnosis,  pathology
Colitis, Ulcerative / complications
Colonic Neoplasms / complications*,  diagnosis,  pathology
Colonic Polyps / complications*,  diagnosis,  pathology
Cross-Sectional Studies
Gastrointestinal Hemorrhage / etiology*
Hemorrhoids / complications,  diagnosis
Middle Aged
Practice Guidelines as Topic
Rectal Diseases / complications*
Ulcer / complications*
Comment In:
Endoscopy. 2012 Feb;44(2):217   [PMID:  22271033 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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