Rectal bleeding is a for the use o...

Rectal bleeding is a for the use of all patient com-plaint, usually presenting as posterity on the toilet paper or in the toilet receptacle The differential diagnosis for this vexed question includes hemorrhoids, solitary rectal sore diverticular bleeding, angiodysplasia, and proctitis. Because the mostly serious cause is malignancy, colonoscopy many times is recommended, although the usefulness of the application of mind in this situation is unclear. Lieberman reviewed the potential management strategies for patients with minor rectal bleeding.

Careful history alone can be useful if the pretest likelihood of malignancy is extremely subdued The latter may be constant in persons younger than 40 years with no family history of colorectal cancer. Colonoscopy may reveal more [i]or[/i] less other important pathology such as colitis or solitary sore but these patients often have additional symptoms. Patients with significant bleeding or a family history of colorectal cancer should have colonoscopy. Anoscopy can identify hemorrhoids and anal fissures, nevertheless the common nature of these question s does not eliminate the possibility of an additional pathology that might actually be responsible for the rectal bleeding. Flexible sigmoidoscopy may be useful in patients younger than 40 years, because greatest in number lesions in this age arrange are located in the distal colon if it were not that efficacy is lower in older patients. In someones 40 to 59 years of age, the prevalence rate of colorectal cancer increases, and colon evaluation should be performed in patients with rectal bleeding. Colonoscopy is the best trial because barium or computed tomography imaging can miss significant colon pathology and tricky mucosal lesions.

Small colonic polyp in subordination to 10 mm in diameter are commonly fix Most are adenomas, with lesions in the right colon more likely to be neoplastic than those in the left colon Small polyp in the distal colon are equally likely to be adenomatous or hyperplastic polyp The appearance of distal adenomas increases the risk of proximal advanced neoplasias. Although small-polyp risk for high-grade dysplasia or cancer is les than 05 percent biopsy is useful to deter-mine that will be surveillance and management.

Care of patients with small distal polyp may include no further evaluation if the polyp is hyperplastic. If the polyp is an adenoma, colonoscopy may be appropriate, especially if risk factors for colorectal cancer are at hand although advanced proximal neoplasia risk in patients younger than 59 years is grave Colonoscopy is appropriate if the distal polyp is an adenoma, if histology is unknown, or if the patient is 60 years or older Surveillance colonoscopy is indicated at least each five years in low-risk patients who had the same to two small adenomas remov Patients discovered to have three or more small tubular adenomas and those who have a more advanced adenoma that was completely remov should have surveillance colonoscopy each three years. These recommendations all assume that bowel preparation was adequate and that the examination was finished to the cecum. High-risk patients should be re-evaluated common year after the initial colonoscopy and then, if the examination is negative, each three to five years.

The author finishs that minimal rectal bleeding and small distal colon polyp are universal Malignancy risk is low in young patients who do not have a family history of colorectal cancer. resort of rectal bleeding should be managed with examination of at least the distal colon If a small polyp is base and noted to be adenomatous upon biopsy histology, colonoscopy is commited Colonoscopy is not recommended if the small distal polyp is noted to be hyperplastic.

Lieberman D Rectal bleeding and diminutive colon polyp Gastroenterology April 2004;126:1167-74

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