Colonoscopic findings in patients with hemorrhoids, rectal bleeding and normal rectoscopy

Within a period of 18 months, 387 patients were referred to the Proctologic Service at the Chaim Sheba Medical Center because of recurrent rectal bleeding. Hemorrhoids were found in 194 of these patients and further investigation showed that 45 of the 194 patients (23.2%) had other coexisting colonic pathology (12 cancers, 28 polyps, 4 inflammatory bowel diseases and 1 angiodysplasia). Sixteen of 40 patients with diverticulosis and 13 of 30 patients with hemoglobin less than 11 g/dl had additional colonic pathology. Single-contrast barium enema, which was used in this survey for screening of the colon, proved to be inaccurate. In view of the issue of cost-effectiveness, this study suggests that patients with recurrent rectal bleeding and hemorrhoids (Grades II and III) who had normal rectoscopy should be further investigated by double-contrast barium enema if they are greater than 40 years of age. All patients with anemia, diverticulosis or abnormal findings in barium enema should undergo total colonoscopy.