Abstract
The study group consisted of 102 patients that presented for evaluation of rectal bleeding. All patients were 50 years of age or less and were evaluated with a flexible endoscope and an anoscope. The findings from each examination were recorded independently. Sigmoidoscopy and anoscopy were performed in 56 patients less than age 40 (group I), and colonoscopy and anoscopy were performed on 46 patients between the ages of 40 but less than 50 years (group II). Anoscopy was superior to flexible endoscopy in detecting hemorrhoids in group I (P<0.001) and group II (P<0.004). The guaiac status of patients was not influenced by the presence of hemorrhoids. Three patients in group I and eight patients in group II had polyps. The likelihood of finding a polyp was not influenced by the guaiac status of the patients. Three patients in group I and one patient in group II had anal fissures that were missed with flexible endoscopy and detected with anoscopy. Five of 102 patients were noted to have diverticula; all of these were in group II. However, this was not felt to be the source of the bleed given the clinical history. Overall, six patients had colitis; all but one of these patients were less than 40 years of age. Flexible endoscopy and anoscopy provide complimentary information in middle-aged adults with rectal bleeding.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Forde K, Waye J: Is there a neeed to perform full colonoscopy in a middle-age person with episodic bright red blood per rectum and internal hemorrhoids? Am J Gastroenterol 84:1227–1228, 1989
DeCosse: Investigation of rectal bleeding. Lancet 1:195–197, 1989
Cheung PSY, Wong SKC, Boey W, Lai CK: Frank rectal bleeding: A prospective study of causes in patients over the age of 40. Postgard Med J 64:364–368, 1988
Guillem JG, Forde KA, Treat MR, Neugat AI, Bodian CA: The impact of colonoscopy on the early detection of colonic neoplasms in patients with rectal bleeding. Ann Surg 206:606–611, 1987
Danesh BJ, Spiliadis C, Williams CB, Zambartas CM: Angiodysplasia-an uncommon cause of colonic bleeding: colonoscopic evaluation of 1,050 patients with rectal bleeding and anemia. Int J Colorect Dis 2:218–222, 1987
Goulston K, Cook I, Dent O: How important is rectal bleeding in the diagnosis of bowel cancer and polyps? Lancet 8501:261–265, 1986
Des Marez B, Adler M, Buset M, Ansay J, Delcour C, Jeanmart J, Finne R, Cremer M: The value of colonoscopy in the diagnosis and management of severe hematochezia. Mt Sinai J Med 53:478–481, 1986
Dehn T, McGinn FP: Causes of ano-rectal bleeding. Postgrad Med J 58:92–93, 1982
Shinya H, Cwern M, Wolf G: Colonoscopic diagnosis and management of rectal bleeding. Surg Clin North Am 62:897–903, 1982
Forde K: Colonoscopy in acute rectal bleeding. Gastrointest Endosc 27:219–220, 1981
Brand EJ, Sullivan BH, Sivak MV, Rankin GB: Colonoscopy in the diagnosis of unexplained rectal bleeding. Ann Surg 192:111–113, 1980
Teague RH, Manning AP, Thornton JR, Salmon PR: Colonoscopy for investigation of unexplained rectal bleeding. Lancet 1:1350–1352, 1978
Fleischer DE, Goldberg S, Browning T, Cooper J, Friedman E, Goldner F, Keeffe E, Smith L: Detection and surveillance of colorectal cancer. JAMA 261(4):580–585, 1991
Mant A, Bokey LE, Chapuis PH, Killingback M, Hughes W, Koorey SG, Cook I, Goulston KJ, Dent O: Rectal bleeding; do other symptoms aid in diagnosis? Dis Colon Rectum 32:191–196, 1989
Funch D: Diagnostic delay in symptomatic colon cancer. Cancer 56:2120–2124, 1985
Jong CR, Kyu TL: The causes and management of lower GI bleeding: A study based on clinical observations at Hanyang University Hospital. Gastroenterol Jpn 26(suppl 3):101–106, 1991
Kang JY: Investigation Of Rectal Bleeding. Singa Med J 32:327–328, 1991
Fleisher DE, Goldberg SB, Browning TH, Cooper JN, Friedman E, Goldner FH, Keeffe EB, Smith L: Detection and Surveillance of Colorectal Cancer. JAMA 261(4):580–585, 1989
Boley SJ, DiBiase A, Brandt LS, Frank MS: Severe lower intestinal bleeding: Diagnosis and treatment: Clin Gastroenterol 10:65, 1981
Welch CE, Athanasoulis CA, Galdabini JJ: Hemorrhage from the large bowel with special reference to agiodiyplasia and diverticula disease. World J Surg 2:73, 1978
Behringer GE, Albright NL: Diverticular disease of the colon. A frequent cause of massive rectal bleeding. Am J Surg 125:419, 1973
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Korkis, A.M., McDougall, C.J. Rectal bleeding in patients less than 50 years of age. Digest Dis Sci 40, 1520–1523 (1995). https://doi.org/10.1007/BF02285201
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02285201