Audit on Patients Admitted with Fresh PR Bleeding Due to Non-Anal Causes
Issue: 2023 - Volume 6 [Issue 2]
V. B. Pathirana *
Department of General Surgery, National Hospital, Sri Lanka.
*Author to whom correspondence should be addressed.
Aim: To audit the diagnoses, management and outcome of patients presenting with fresh PR bleeding due to non-anal causes.
Place and Duration: Emergency Surgical ward – National hospital Sri Lanka – 2019 November to 2020 October.
Methodology: All patients admitted with acute fresh PR bleeding were identified from patient records during this time period and based on final diagnosis, patients with anal causes, post-surgical/ polypectomy patients, known cancer patients and traumatic causes were excluded. Comorbidity, drop of haemoglobin, duration of hospital stay, imaging and colonoscopy findings, management and outcome data were collected from the records with patient consent.
Results: 18 patients were included in the study, and there were two [11.1%] patients with small bowel causes and 3 with no identified cause for the bleeding. Colitis was the commonest colonic cause of bleeding among the patients. CT and colonoscopy are complementary to each other in diagnosing the cause for bleeding with good diagnostic yield. Overall patients had good outcomes with conservative management and majority of patients [66.7%] were managed without blood transfusion. A drop of haemoglobin was the only factor shown significantly associated with a hospital stay [P< 0.003]. Age, comorbidities did not show such association.
Conclusion: Most of the time fresh bleeding due to colonic causes can be managed conservatively and non-colonic causes often need surgical intervention. A drop of haemoglobin is the main factor that determined the hospital stay.
Keywords: Fresh per rectal bleeding, haematochezia, colitis, diverticular bleeding, jejunal diverticula
How to Cite
Kevin A Ghassemi, Dennis M Jensen. Lower GI Bleeding: Epidemiology and Management; Curr Gastroenterol Rep. 2013 Jul;15(7):10.1007/s11894-013-0333-5. DOI: 10.1007/s11894-013-0333-5
Titilayo Adegboyega, David Rivadeneira, Lower GI Bleeding: An Update on Incidences and Causes; Clin Colon Rectal Surg. 2020 Jan;33(1):28–34. Published online 2019 Nov 11. DOI: 10.1055/s-0039-1695035
Benita KT Tan, Charles BS Tsang, Denis CNK. Nyam, Yik Hong Ho. Management of Acute Bleeding Per Rectum. Asian Journal of Surgery. JANUARY 2004;27(1).
Diagnosis and management of acute lower gastrointestinal bleeding: European Society of Gastrointestinal Endoscopy (ESGE) Guideline; Endoscopy. 2021;53: 850-868. DOI: https://doi.org/10.1055/a-1496-8969
Oakland K, et al. Diagnosis and management of acute lower gastrointestinal bleeding: Guidelines from the British Society of Gastroenterology. Gut. 2019;0:1–14. DOI: 10.1136/gutjnl-2018-317807.
John Frost, Faye Sheldon, Arun Kurup, Benjamin R Disney, Sherif Latif. An approach to acute lower gastrointestinal bleeding. Frontline Gastroenterol. 2017 Jul;8(3):174–182.
Jeremy R Wortman, Wendy Landman, Urvi P Fulwadhva, Salvatore G Viscomi and Aaron D Sodickson. CT angiography for acute gastrointestinal bleeding. Br J Radiol. July 2017;90(1075):20170076
Dekey Y Lhewa, Lisa L Strate. Pros and cons of colonoscopy in management of acute lower gastrointestinal bleeding. World J Gastroenterol. 2012 Mar 21; 18(11):1185–1190.
Kalpit Devani, Dhruvil Radadiya, Paris Charilaou, Tyler Aasen, Chakradhar M Reddy, Mark Young. Trends in hospitalization, mortality, and timing of colonoscopy in patients with acute lower gastrointestinal bleeding. Endosc Int Open. 2021 Jun;9(6):E777–E789.
Lisa L Strate, Ian M Gralnek. Management of Patients with Acute Lower Gastrointestinal Bleeding. Am J Gastroenterol. 2016 Apr;111(4):459–474. DOI: 10.1038/ajg.2016.41