Role of sigmoidoscopy in the diagnosis of lower GIT bleeding

Abstract

Background: Diseases of the lower gastrointestinaltract (GIT) are more common worldwide. Proper diagnosisprior to surgical or prolonged medical intervention isessential. Colonscopy and sigmoidoscopy are the maintools to reach this goal.Aims: This article aims to assess the role of sigmoidoscopyin the identification of the etiology of lower GITbleeding (with or without diarrhea) before GIT surgeryor long-term medication. It compares the findings withproctoscopic examination combined with per-rectal examinationand sigmoidoscopy that followed by electivecolonoscopy. It is performed when no pathology is identifiedby the above two approaches.Material and methods: This prospective descriptivestudy was carried out on patients attended the Gastrointestinaland Hepatology center at Azadi Teaching hospital/Kirkuk during the period from March 2011 to February2014 (35 months). Six hundred cases presentedwith mild to moderate lower GIT bleeding with or withoutchronic diarrhea. The patients underwent examinationby proctoscope and per-rectal examination followedby sigmoidoscopy. Then, extended to total colonoscopyand compare the sensitivity of each case.Results: This study was carried out on 600 patientscomprised of 389 (65%) males and 211 (35%) femalesbetween 10 and 80 years of age. The cases were dividedinto two groups according to the mode of presentationas follows: 1) A group of 318 patients presentedwith bleeding per-rectum (called as a 1st group); whilethe rest (i.e. 282 cases) are presented with chronic diarrheawith lower GIT bleeding (named as a 2nd group).The findings showed that the causes of bleeding accordingto sigmoidoscopy in the 1st group are as follows: 111(35%) patients had hemorrhoid, 67 (21%) had polyps, 54(17%) with tumor and proctitis in 38 (12%). Additionally,16 (5%) had a solitary rectal ulcer, and other pathologieswere found 32 patients (10%). On the other hand, in the2nd group (chronic diarrhea with blood) hemorrhoid wasseen in 60 (21%), colitis in 166 (59%), familiar adenomatouspolyps found in 6 (2%) patients, 2 (0.7%) patientshad the peutz-jeghers syndrome. Furthermore, other lesionswere polyps with 7 (2.5%) patients, but 41 (17%)patients cannot detect the pathology. In the 1st group, theSensitivity of sigmoidoscopy compared to proctoscopywas 91%, 66%, respectively. Finally, in both groups, thesigmoidoscopy sensitivity in compare with proctoscopewas 87% and 59%, respectively; while the colonoscopysensitivity was 100% and 99%, respectively.Conclusion: Sigmoidoscopy is necessary for the diagnosisof lower GIT bleeding in spite of age group beforeany anal surgery. Furthermore, elective colonoscopy candiagnose more pathologies.