Etiologic Factors, Risk Factors, Diagnoses, and Importance of Colonoscopy in Patients Hospitalized Due to Lower Gastrointestinal Bleeding From Emergency Services

Objective: It is estimated that 3 out of 7 people suffer lower gastrointestinal bleeding (LGIB) at some point in life, and it is a frequent cause of emergency department admission. In this study, we aimed to evaluate the etiological factors, risk factors, diagnoses and the importance of colonoscopy in patients with LGIB. Material and Methods: Forty-three cases with LGIB who were referred to the Emergency Department of Adana Numune Training and Research Hospital, between January 2010 and January 2011 and examined with colonoscopy in the Gastroenterology and General Surgery Departments were retrospectively investigated. Demographical characteristics, etiology, risk factors, diagnoses and treatment modalities were determined.Results: Twenty-five patients with LGIB (58.1%) were male and 18 (41.9%) were female. The patients were aged between 18 and 85 years. Mean age (±SD) was 56.4±22.4. The average age (36.1±15.7) of patients with hemorrhoids and anal fissures were lower than others (69.7±14.9) (p<0.001). Signs and symptoms of the patients on admission were; melena 13 (30.2%) cases, hematemesis 1 (2.3%) case, hematemesis-melena 1 (2.3%) case, hematochezia 25 (58.1%) cases, abdominal pain 13 (30.2%) cases, and other reasons 1 (2.3%) case. Also, 7 patients (16.2%) had tachycardia, 4 (9.3%) had fever and 5 (11.6%) had hypotension. In terms of the associated diseases, 13 (30.2%) had hypertension, 4 (9.3%) had diabetes-mellitus, 6 (14.0%) had coronary artery disease, 2 (4.7%) had stroke, 1 (2.3%) had heart valve disease, and 1 (2.3%) had CRF. The anamnesis of LGIB was positive in 15 (34.9%) cases while smoking was positive in 14 (32.6%) cases. Risk factors for the disease were, use of aspirin for 8 (18.6%) cases, NSAIDs for 5 (11.6%) cases, anticoagulant for 2 (4.7%) cases, steroid for 2 (4.7%) cases, aspirin+NSAIDs for 2 (4.7%) cases and NSAIDs+anticoagulant for 1 (2.4%) case. Colonoscopic diagnosis of the patients were hemorrhoids for 14 (32.6%) cases, diverticulosis for 8 (18.6%) cases, ulcerative colitis for 7 (16.3%) cases, colorectal carcinoma for 4 (9.3%) cases, angiodysplasia for 3 (6.9%) cases and anal fissure for 3 (6.9%) cases. Colonoscopy was nondiagnostic in only four (9.3%) patients. 13 (30.2%) patients were given red blood cell transfusion, 7 (16.2%) antibiotics, 5 (11.6%) patients were treated endoscopically and 4 (9.3%) patients received surgical treatment.Conclusion: Diverticulosis was the most common cause of LGIB in older patients while ano-rectal diseases in younger patients. Most bleeding stopped spontaneously, and the remainder were succes