Arifa Manzoor, Syed Aslam Shah, Aatif Inam.
Etiologic Spectrum of Bleeding Per Rectum in Surgical Outpatient Department of a Tertiary Care Hospital.
Ann Pak Inst Med Sci Jan ;7(4):180-5.

Objective: To document the etiological spectrum of bleeding per rectum in relation to age and gender of patients who present with bright red, rectal bleeding primarily in surgical outpatient department (SOPD) of a tertiary care hospital. Study Design: Descriptive study. Place and Duration of Study: A prospective study was conducted at SOPD of General Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad for a period of six months from 17 June 2008 to 16 December 2008. Materials and Methods: The study included 200 patients who complained of bleeding per rectum at the time of their presentation in SOPD. After taking history and doing physical examination further laboratory tests and specialized investigations were ordered where necessary to reach the final diagnosis. Results: Mean age of patients was 38 + 16 years with a range from 13 to 80 years. Male to female ratio was 1:1.2. Haemorrhoids (58%) presented as the most common cause of bleeding per rectum followed by fissure-in-ano (27%) in all age groups and genders. Colorectal carcinoma contributed (8%), rectal prolapse (2.5%), colorectal polyps (2.0%), ulcerative colitis (1.0%), solitary rectal ulcer syndrome (1.0%) and diverticular disease (0.5%). Conclusion: Haemorrhoids are the most common cause of bleeding per rectum followed by fissure-in-ano which is more common in our setup. In cases of bleeding per rectum the surgeon should always keep a high suspicion of colorectal carcinoma.

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