Angtuaco T L, Reddy S K, Drapkin S, Harrell L E, Howden C W
Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA.
Am J Gastroenterol. 2001 Jun;96(6):1782-5. doi: 10.1111/j.1572-0241.2001.03871.x.
Urgent colonoscopy is often recommended to evaluate acute rectal bleeding. However, it may not identify a source because of blood in the lumen or inadequate preparation. Our aim was to determine the utility of urgent colonoscopy as the initial test for acute rectal bleeding.
This was a retrospective chart review of all patients discharged in 1997 and 1998 with an International Classification of Diseases, 9th Revision, code for hematochezia or rectal bleeding.
We identified 514 charts but excluded 424 because of inaccurate coding. In the 90 with confirmed acute rectal bleeding, colonoscopy was the initial test in 39; age, sex, and race distributions were similar to those who did not have colonoscopy. A definite source of bleeding was seen at colonoscopy in only three patients, a probable source in 26, and no source in 10. Therapeutic intervention in four patients with a definite or probable source was successful in three. The commonest reasons for not performing urgent colonoscopy were bleeding from presumed hemorrhoids or bleeding that was clinically insignificant. Spontaneous resolution of bleeding and length of hospital stay were not affected by urgent colonoscopy. Five patients had surgery for unrelated reasons. In-hospital mortality was 2% and was unrelated to bleeding.
Urgent colonoscopy as the initial investigation in acute lower GI tract bleeding probably does not alter the outcome in most cases. Identification of a definite bleeding source leading to successful therapeutic intervention is rare. Spontaneous resolution is frequent, length of hospital stay is similar, and clinical outcome is excellent regardless of whether or not urgent colonoscopy is performed.
对于急性直肠出血，常建议进行紧急结肠镜检查以评估病情。然而，由于肠腔内有血液或准备不充分，可能无法确定出血源。我们的目的是确定紧急结肠镜检查作为急性直肠出血初始检查的效用。
这是一项对1997年和1998年出院的所有患有国际疾病分类第九版便血或直肠出血编码的患者进行的回顾性病历审查。
我们识别出514份病历，但因编码不准确排除了424份。在90例确诊为急性直肠出血的患者中，39例将结肠镜检查作为初始检查；其年龄、性别和种族分布与未进行结肠镜检查的患者相似。结肠镜检查仅在3例患者中发现明确的出血源，26例中发现可能的出血源，10例未发现出血源。对4例有明确或可能出血源的患者进行的治疗干预，3例成功。不进行紧急结肠镜检查的最常见原因是推测为痔疮出血或临床上无意义的出血。出血的自发缓解和住院时间不受紧急结肠镜检查的影响。5例患者因无关原因接受了手术。住院死亡率为2%且与出血无关。
在大多数情况下，紧急结肠镜检查作为急性下消化道出血的初始检查可能不会改变结果。识别导致成功治疗干预的明确出血源很少见。出血常自发缓解，住院时间相似，无论是否进行紧急结肠镜检查，临床结果都很好。
