1. Value of digital rectal examination and bedside anorectoscopy in the evaluation of patients with lower gastro-intestinal bleeding
F Cherbanyk and G Lombardo
A Meyer, JM Michel, B Egger

2. Background Incidence of acute lower gastrointestinal bleeding:
21 patients/ /year
This incidence increases 200-fold between the 3rd and 9th decade
The assessment of hematochezia is often expensive and invasive (endoscopy, CT scan, angiography, scintigraphy).
Digital rectal examination and anorectoscopy are minimally invasive and inexpensive tools for the diagnosis of hematochezia
Longstreth et al., Am J Gastroenterol 1997;92:419

3. Objective
To assess the value of digital rectal examination and bedside anorectoscopy for the evaluation of hematochezia at our Emergency Department (ED) fr
To determinate the proportion of patients presenting with lower gastrointestinal bleeding related to the underlying pathology (benign or malignant) in the anorectal region

4. Patients & Methods
Retrospective analysis of an ongoing prospective database in our Surgical Department
Study period:
Inclusions criteria’s: all patients > 18 years old admitted to the ED with hematochezia and hospitalized on our surgical ward
Exclusions criteria’s: hemodynamic instability, pediatric cases
Patients underwent digital rectal examination and anorectoscopy at the ED by a incensed surgeon
All patients underwent colonoscopy (Gastroenterologist) during hospitalization in order to exclude synchronous colonic lesions

5. Results n=105 Study Group All lesions were confirmed by colonoscopy!
Anorectal localisation n=54 (51%)
Non anorectal localisation n=51 (49%)
Neoplastic
n=28 (26,6%)
Non neoplastic
n=26 (24,4%)
Neoplastic
n=32 (30,2%)
Non neoplastic
n=19 (18,8%)
Study Group
All lesions were confirmed by colonoscopy!

6. Results
Anorectal lesions situated between 0 and 15cm from the anal marge (n =54)
No synchronous lesions found at colonoscopy
Non-Neoplasic Lesions
n=26 (24,4%) 8
Hemorroids 5
Ulcerations-erosions
Others ** 4
Rectocolitis
Post polypectomy
Neoplasic Lesions*
n=28 (26,6%) 17
Cancer 11
Benign polyps
* proven at histology
** Cryptogenic, anastomotic bleeding, post actinic, prolapsus

7. Conclusions
50% of stable patients presenting with hematochezia at our ED had lesions, confirmed by colonoscopy, in the anorectal region
Digital rectal examination and anorectoscopy at the ED allows to make a preliminary diagnosis in 50% of patients
Additional time-consuming and expensive investigations, as CT-scan, gastroscopy, angiography and others may be even avoided
However, 50% of patients require additional investigations such as colonoscopy or others due to lesions situated higher up in the colon

8. Take Home Message
In patients presenting with hematochezia at the ED, simple digital rectal examination combined with bedside anorectoscopy allows to make a preliminary diagnosis in 50%