Is full colonoscopic examination necessary in young patients with fresh bleeding per rectum
Khalid AB et al. – Endoscopic lesions in patients younger than 40 years with fresh bleeding per rectum(FBPR) are found mostly in the distal colon and hence flexible sigmoidoscopy seems to be a reasonable evaluation tool in young patients with no other alarm symptoms.Methods
- Consecutive patients aged 18 – 50 years who were scheduled to undergo full colonoscopy for FBPR at Aga Khan University Hospital between May 2007 and October 2009 were enrolled in the study after giving informed consent.
- FBPR was defined as the passing of fresh blood per rectum with or without stools and/or noticing blood in the toilet bowl.
- Lesions were characterized as proximal or distal to the splenic flexure.
- Patients with positive family history of colorectal cancer, bleeding requiring blood transfusion, bleeding diathesis, or iron deficiency anemia were excluded.
- Total of 379 patients met the inclusion criteria and were analyzed. Of these, 248 patients (65.4 %) were under 40 years of age and 131 (34.6 %) were aged 40–50 years.
- Mean hemoglobin was 12.93±1.78 g/dL.
- In patients <40 years, seven (2.8 %) adenomatous polyps and malignant lesions were found, all of which were located in the distal colon.
- In patients aged 40–50 years, 10 (7.6 %) adenomatous polyps and malignant lesions were detected, one of which was located in the proximal colon.
- On univariate analysis, malignant and adenomatous lesions were significant in the 40–50 years age group (P=0.031; OR, 2.84; 95 %CI 1.05–7.65).