The Value of Colonoscopy in Assessing Rectal Bleeding in Patients Referred From Outpatient Care Units in Erbil, Iraq.

BACKGROUND AND OBJECTIVES

Rectal bleeding denotes bleeding from the lower colon or rectum, specifically from a location distal to the ligament of Treitz. Lower gastrointestinal bleeding (LGIB) is very common in adults of all ages. This study aimed to review the diagnostic findings of colonoscopy in outpatients who had nonurgent rectal bleeding and identify common pathologies causing rectal bleeding in patients at Erbil and Rizgary Teaching Hospitals in Iraq.

METHODS

We selected 400 male and female patients from outpatient departments with evidence of rectal bleeding, referring them to the gastroenterology units of Erbil and Rizgary Hospitals in Erbil, Iraq. Patients with upper gastrointestinal bleeding (UGIB) sources and other symptoms were excluded from the study. We prepared the bowel, subjected all patients to a colonoscopy, and recorded the findings. Where necessary, biopsies were also taken. A diagnosis was made based on the colonoscopic findings.

RESULTS

The total number of patients was 400. Their mean age + SD was 44.9 + 15.9 years, ranging from 18 to 83 years, and the highest proportion of the diagnoses was hemorrhoids, either alone (n = 140, 35%) or in combination with other diseases. The results indicated that 48 (40%) males aged < 45 years had hemorrhoids, compared with 33 (33.7%) males aged ≥ 45 years; for females, 29 (30.9%) in those aged < 45, compared to 30 (34.1%) in those aged ≥ 45. The next two prevalent diagnoses in the total sample were inflammatory bowel disease (n = 31, 7.8%) and colorectal tumor (n = 37, 9.3%). It was observed that around one-fifth (n = 79, 19.8%) of the sample was normal.

CONCLUSION

This study highlights the leading causes of LGIB as diagnosed through colonoscopy. The main causes and patterns of LGIB across gender and age groups in Erbil were generally similar to other settings but with some differences. Hemorrhoids caused the most rectal bleeding, followed by tumors and then inflammatory bowel disease. The older group had more cases of diverticulosis than the younger group. Although most findings were benign, colonoscopy should be strongly considered for outpatients (young and old) with nonurgent rectal bleeding.