Colonoscopic evaluation of severe hematochezia in an oriental population

Background and Study Aims: Hematochezia is a common clinical problem. When the bleeding is brisk and continuous it requires prompt hospital admission and careful diagnostic evaluation and management. Colonoscopy has become th e first-line investigative modality in patients presenting with severe hema tochezia in many centers, including ours. A retrospective review was carrie d out to evaluate the effectiveness of colonoscopy in determining the cause of severe hematochezia in our Oriental population. Patients and Methods: One hundred and ninety patients with severe hematoche zia underwent colonoscopy at the National University Hospital, Singapore, f rom 1 January 1988 to 31 December 1994. Their records were retrieved and th e data analyzed for sex, age, presentation, concomitant medical conditions, prevalence of recent non-steroidal anti-inflammatory drugs ingestion, past history of hematochezia, investigations, subsequent interventions and outc ome. Results: Colonoscopy as the fist-line investigative modality identified the site and cause of hematochezia in 78% (148/190) of cases. The site of blee ding remained "obscure" even after additional investigations in 15% (29/190 ) of cases. The commonest cause of severe hematochezia in our Oriental popu lation was diverticular disease (30%, 57/190) with right-sided diverticular bleeding constituting 44% (25/57) of these cases. Overall, bleeding stoppe d spontaneously in 81% (154/190) of cases. Surgery was performed in 16% (30 /190) of cases. The mortality related to severe hematochezia in this series was 5% (9/190). Conclusions: The diagnostic efficiency of colonoscopy in defining the site and cause of severe hematochezia in the Oriental population is comparable t o most Western series. The commonest cause of severe hematochezia in our po pulation was diverticular disease.