Endoscopic evaluation of the colorectum in patients presenting with haematochezia at Korle-Bu Teaching Hospital, Accra

Abstract

Background: Colorectal endoscopy is the gold stan- dard investigation of the large bowel in patients with rectal bleeding and is employed as a means of secon- dary prevention of colorectal cancer. Aim: To determine the frequency of benign lesions and carcinomas in patients who underwent colorectal endo- scopy because of rectal bleeding and to evaluate the role of endoscopy in secondary prevention of colorectal carcinoma in our centre. Method: A retrospective study was undertaken on pa- tients who underwent colorectal endoscopy between January 1995 and December 2000 for rectal bleeding. Results: Five hundred and ninety six (596) patients were studied. Males were 403 and females 93, mean age 50.9 (SD 7.07). Three hundred and ten patients (52%) had rigid proctosigmoidoscopy, flexible sigmoi- doscopy 105 (17.6%) and colonoscopy 181 (30.4%). Of those who had colonoscopy complete examination of the colon was achieved in 55 patients (30.4%). Those in whom colonoscopy was incomplete had dou- ble contrast barium enema. Haemorrhoids were the commonest disease diagnosed, 316 patients (53%). Co- lorectal carcinoma 39 patients (6.7%), non-specific co- litis 34 patients (5.7%), diverticular disease 27 patients (4.5%) and adenomatous polyps 17 patients (2.9%) were the next common disease. Less common condi- tions were ulcerative colitis, rectal schistosomiasis and angiodysplasia. In 125 patients (21.0) the cause of bleeding could not be found. Conclusion: An appreciable number of the patients with rectal bleeding had serious pathology that was di- agnosed early by endoscopy confirming the important role of endoscopy in secondary prevention of colorectal carcinoma. The low success rate of full colonoscopy underscores the need for training in this procedure.