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Colonoscopy in the diagnosis of unexplained rectal bleeding.
Diseases of the Colon and Rectum
|November 1, 1978
Summary
Colonoscopy offers a 17% diagnostic yield for obscure rectal bleeding when initial exams fail. Physician-observed bleeding significantly improves diagnostic success compared to patient reports.
Area of Science:
- Gastroenterology
- Colorectal Surgery
Background:
- Obscure rectal bleeding often requires advanced diagnostic methods after initial evaluations.
- Standard proctoscopy and barium enema may not identify the source of bleeding.
Purpose of the Study:
- To determine the diagnostic yield of colonoscopy in patients with obscure rectal bleeding.
- To evaluate the reliability of patient-reported bleeding versus physician-observed bleeding.
Main Methods:
- Colonoscopy was performed on 105 patients with unexplained rectal bleeding.
- Diagnostic yield was compared based on bleeding observation (physician vs. patient).
Main Results:
- Colonoscopy yielded a diagnosis in 17% of cases (18 of 105 patients).
- Lesions identified included carcinomas, polyps, colitis, and proctitis.
- Physician-observed bleeding had a higher diagnostic yield (22.5%) than patient-reported bleeding (5.9%).
- Most lesions (16 of 18) were located in the left colon.
Conclusions:
- Colonoscopy is valuable for diagnosing obscure rectal bleeding when initial workup is inconclusive.
- Physician-observed bleeding is a more reliable indicator for colonoscopy referral.
- Standard workup should include history, physical exam, sigmoidoscopy, and barium enema; colonoscopy is indicated for persistent or observed colonic bleeding.