Diagnostic evaluation of patients presenting with bleeding per rectum by colonoscopy

Rectal bleeding is a manifestation of lower gastrointestinal bleed, which means bleeding from a site distal to ligament of Treitz. Annual incidence of this problem has been estimated to be 20% and mortality as 11%. Patients complaining of haematochezia are suspected of having lower GI bleeding and proctosigmoidoscopy followed by colonoscopy is the examination of choice for diagnosis and treatment. Previous evidence suggested that in our country, frequencies of different aetiologies of lower GI bleed are different from the West. This study validated the previous findings. The Objective of this study was to determine the causes of rectal bleeding in adult patients at Military Hospital, Rawalpindi. One hundred and five adult patients with visible rectal bleed, irrespective of their gender were selected by non-probability convenient sampling from general medical OPD and general medical wards. Patients with suspected upper GI source of bleeding; haemorrhoidal bleed and acute infectious diarrhoea were excluded from the study. All patients were subjected to fibre-optic colonoscopy after necessary preparation and findings were recorded. Biopsies taken from suspected lesions were clinically indicated. Diagnosis was based on colonoscopic and histopathologic findings. A total of 105 patients [77 male and 28 female] with mean age 41.04 yrs were part of the study. Colonoscopy showed abnormal findings in 85 [84%] patients. The commonest diagnosis was ulcerative colitis, which was found in 48 [46%] patients. It was followed by colorectal carcinoma, 11 [10%] patients, and non-specific colitis, 9 [8%] patients. Other less frequent findings were colonic diverticuli, 7 [6%] patients, solitary rectal ulcer, 5 [4%] patients, colonic polyps in 3 [2.5%] patients and one case each of telangiectasia and Crohn's disease. Colonoscopy has very high diagnostic yield and would be recommended in the workup of patients presenting with bleeding per rectum. Ulcerative colitis was the leading cause of bleeding per rectum in this study; while infrequent findings of Crohn's disease, polyps and diverticuli indicate that these are uncommon in this region

Aetiology and outcome of acute upper gastrointestinal haemorrhage cases admitted to military hospital, Rawalpindi

Acute upper gastrointestinal bleeding remains one of the most commonly encountered presentation in the emergency department of hospitals world wide. It has multifactorial aetiology which varies widely between different geographical areas of the world. Incidence in America ranges from 50-150 cases/100,000/year and in United Kingdom it varies from 100-107/100,000/year. The epidemiological analysis of such cases in Pakistan is yet to be formulated. In the last two decades the advent of state-of-the-art upper gastrointestinal endoscopy has considerably improved the diagnostic and therapeutic modalities in the management of upper gastrointestinal bleeding. This study design included thirty seven patients admitted to Military Hospital Rawalpindi with manifestations of acute upper gastrointestinal haemorrhage between August 1996 and August 1997. Endoscopy was done within seventy-two hours of admission. Male to female ratio was 8:1 and mean age at presentation was 42 years. At admission 48.6% had hematemesis whereas only 5.4% presented with melena alone. Major causes of bleeding were esophageal varices [35.2%], duodenal ulcer [21.6%] and reflux esophagitis [8.1%]. One case of Boerhave's syndrome was also seen. Prior history of NSAIDs intake was obtained in 10.8% and 5.4% gave history of previous episode of bleeding whereas 21.6% had suffered from jaundice. At presentation, haemorrhage was hemodynamically severe in 21.6% who also had Hb of <6 gm/dl with a raised urea level as well. This contributed to the overall mortality of 13.2% being highest with massively bleeding esophageal varices. Out of the 13 cirrhotic patients, 5 had hepatitis B and 3 had hepatitis C. This study signifies predominance of the esophageal varices in incurring morbidity and somewhat higher mortality rate in our population as compared to other studies. These observations necessitate proper multicentre epidemiological survey in order to adequately prevent and effectively combat the adverse outcome of upper gastrointestinal haemorrhage