Internal hemorrhoids: diagnosis with double-contrast barium enema examinations

The authors retrospectively studied 43 patients suspected of having internal hemorrhoids at double-contrast barium enema examination. At endoscopy, 24 patients (56%) had internal hemorrhoids, four (9%) had other pathologic lesions in the rectum without evidence of hemorrhoids, and 15 (35%) had no reported abnormalities in the rectum. Internal hemorrhoids were found at endoscopy in 10 of 20 patients (50%) with lobulated folds extending 3 cm or less from the anorectal junction and 10 of 13 patients (77%) with multiple submucosal nodules. However, no patients with these characteristic radiographic findings were found to have other pathologic lesions in the rectum that had been mistaken for hemorrhoids at barium enema examination. Conversely, three of four patients with lobulated folds extending more than 3 cm from the anorectal junction and one of six patients with solitary nodules had proctitis or rectal neoplasms. Thus, specific criteria are suggested for the diagnosis of internal hemorrhoids on double-contrast barium enema examinations. Suspected hemorrhoids that do not fulfill these criteria should be evaluated endoscopically to rule out other more serious pathologic lesions in the rectum.