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Updated: May 14, 2026
Diagnosis of Hirschsprung's Disease by Immunostaining Rectal Suction Biopsies for Calretinin, S100 Protein and Protein Gene Product 9.5
Published on: April 26, 2019
[Diagnosis of hematochezia in Abidjan Cocody University Hospital (Ivory Coast)]
1Service de gastroentérologie, CHU de Bouake, Côte d'Ivoire. okonanassi@yahoo.fr
Insights
This study found that most colonoscopy lesions in patients with rectal bleeding were in the distal colon. Flexible sigmoidoscopy may be sufficient for low-risk patients, reserving total colonoscopy for high-risk individuals.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Epidemiology
Context:
- Rectal bleeding is a common symptom prompting lower gastrointestinal endoscopy.
- Understanding the prevalence and location of endoscopic lesions is crucial for guiding diagnostic strategies.
- Previous research on lesion distribution in African populations undergoing colonoscopy is limited.
Purpose:
- To determine the prevalence of endoscopic lesions in patients with rectal bleeding.
- To analyze the distribution of these lesions based on patient age and anatomical location within the colon.
- To evaluate the utility of total colonoscopy versus flexible sigmoidoscopy for diagnosing rectal bleeding.
Summary:
- A retrospective study of 1,158 colonoscopies for rectal bleeding (hematochezia) identified lesions in 23.3% of patients.
- Common findings included inflammatory lesions (21.5%), diverticular disease (11.1%), and polyps (10.4%).
- Colorectal inflammatory lesions were more prevalent in younger patients (<45 years), while diverticula were more common in older patients (>45 years). Over two-thirds of significant lesions were located in the distal colon.
Impact:
- The findings suggest that flexible sigmoidoscopy may be an adequate initial diagnostic tool for patients with low to moderate risk of colorectal cancer presenting with rectal bleeding.
- Total colonoscopy should be prioritized for higher-risk individuals.
- This research contributes to optimizing endoscopic resource allocation in regions with potentially different colorectal cancer demographics.
Aim:
To determine the prevalence of endoscopic lesions, according to age and location, in patients with rectal bleeding who underwent total colonoscopy.
Methods:
Retrospective observational study examining records from the hepatogastroenterology department at the Cocody University Hospital (Abidjan) of colonoscopies for rectal examination from September 1, 1991, through August 15, 2007. The data collected and analyzed from the records included age, sex and colonoscopy results. A p value less than 0.05 was considered statistically significant.
Results:
Of 1,158 colonoscopies, 270 (23.3%) were performed for hematochezia: 105 women (mean age: 48.8 years ± 19.9 years, range: 10-96 years) and 165 men (mean age: 46 ± 14.2, range: 21-83 years) with a sex-ratio (M/F) of 1.57. Because colorectal cancer seems to occur at a younger age in Africa, patients were divided into two groups (aged 45 years: 139 [51.5%] and above 45 years: 131 [48.5%]). The abnormalities found were consistent with anal pathologies (16.3%), polyps (10.4%), diverticular disease (11.1%), colorectal inflammatory lesions (21.5%) and carcinoma (7%). Diverticula were significantly more common in those older than 45 years and inflammatory lesions in the younger group (p < 10(-3)). More than two thirds of the significant lesions were found in the distal colon (p < 10(-3)).
Conclusion:
The predominance of distal colon lesions suggests that exploration by flexible sigmoidoscopy can be performed in patients with low to moderate risk of colorectal cancer, with total colonoscopy reserved for the population at high risk.
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