ABSTRACT
This study aims to analyse the patterns of presentation, investigation and surgical management of major colo-rectal diseases admitted to the Department of Surgery, Dammam Central Hospital, one of the major hospitals in the Eastern Province of Saudi Arabia. The case notes of all patients who underwent major colo-rectal procedure [excluding piles and ano-rectal sepsis] over 2-year period [1995 and 1996] were retrospectively reviewed. There were 23 colo-rectal procedures carried out in 21 patients [15 males, 6 females] with mean age of 45 [range 15-75] years during the two year period [1995- 1996]. Fifteen patients [70.4%] were Saudis. The commonest presenting symptoms were: constipation [81%], bleeding per rectum [57%], abdominal pain and discomfort [47.6%], weight loss [42.8%], abdominal mass [19%] and tenesmus [19%]. Ultrasonography was performed in 20 and was informative in 5 cases [mass 3, liver metastases 1 and mesenteric lymphadenopathy in 1]. CT scan was performed in 8 patients and was abnormal in 4. Nineteen patients [90.5%] underwent colonoscopy, which revealed colonic lesions in fifteen patients. Only 3 patients had barium enema that showed malignant lesion in 2. The operations performed were hemicolectomy [eight], anterior resections [four], abdominoperineal resection of rectum [three], Hartmann's procedures [two], reversal of Hartmann's [two], subtotal and total colectomies [three]. Majority of the procedures was carried out for cancer [66.7%], followed by adenoma [9.5%]. There were 4 complications [17%] and 5 deaths [21.7%]; all in patients with cancer. The mean hospital stay was 20 [range 10-67] days. We conclude that colonoscopy is efficiently used at Dammam Central Hospital to investigate large bowel symptoms replacing barium enema. Major colorectal procedures are conducted at a rate of 1 per month. Majority [66.5%] of colonic operations performed were for cancer and that surgery for inflammatory bowel conditions seem to be uncommon