Etiology, Diagnosis and Treatment Options in Chronic Hematochezia Saad N K Saadoon* CABM FICMS, Saad Abdullah Almosawi** FICMS

Abstract

ABSTRACT Background: Chronic hematochezia is recurrent, intermittent, small amount of blood loss per rectum, either bright red or mixed with the stool for more than 3 months duration. It is important symptom of lower gastrointestinal diseases, early endoscopic diagnosis and treatment is mandatory for those patients, even if there is no alarming sign like anemia or weight loss.

Objective: To determine the causes, treatment and the indication of colonoscope or sigmoidoscope for patient complaining of chronic hematochezia in all age group patient and in patient with (low and average risk group) of colorectal cancer (CRC).

Methods: A cross-sectional descriptive study for 400 patients (260 males, 140 females) with chronic hematochezia, their ages was from 20-80years were enrolled in this study from January 2011 to January 2014, patient with chronic hematochezia for more than 3 months duration referred to the GIT center of Al- Imamain Al-Kadhimain Medical City. All patients investigated and examined and divided to two group above 45 years (average risk), and below 45 years (low risk) for CRC, and detail history was taken for any family history of CRC, and for alarming signs than, patient examined either by sigmoidoscope or colonoscope according to the type of risk

Results: Diagnosis confirmed in 93% (370) patients, while no cause was detected in (7.5%) 30 patients. Non-serious lesion was seen in 218 patients (54.5%), and the hemorrhoid was the commonest non-serious lesion and was seen in (192) patients. Other non- serious lesion was angiodysplasia, solitary rectal ulcer (SRU) and diverticulosis was seen in 26 patients (6.5%). While serious lesion was detected in 152 patients represent (38%) as follow (63) patients (15.7%) with colonic malignancy and FAP, polyp seen in (40) patients (10%) and (49) patients (12.3%) has IBD. Sixteen patients (4%) the lesion was in the proximal colon.

Conclusion: Any patient with chronic hematochezia at all age group advised for early medical consultation. Hemorrhoid is the commonest cause of chronic hematochezia in all age group, but because of increased risk of CRC in young patient, colonoscopy is strongly indicated for patient less than 45 years old patient with alarming signs and all patients above 45 years old, irrespective to the alarming signs (anemia, weight loss and anorexia) which may appear later.