Krwawienie z dolnego odcinka przewodu pokarmowego pułapką diagnostyczną – badanie prospektywne 200 pacjentów przebadanych w Przyszpitalnej Poradni Chirurgicznej Szpitala w Wołominie

*Przemysław Ciesielski¹, Małgorzata Kołodziejczak², Krzysztof Górnicki¹

Streszczenie
Lower gastrointestinal bleeding is one of the most common symptoms in patients coming to the Surgical Outpatient Clinic and it is an alarming symptom that requires in-depth diagnostics.
Aim: The purpose of the study was to increase the detectability of early stage proctological diseases and to evaluate the incidence of diseases that cause lower gastrointestinal bleeding.
Material: In years 2006 and 2007, Hospital Outpatient Clinic in Wołomin offered control examinations to patients aged 40 or older who presented with at least one of the following symptoms considered to be risk factors for colorectal carcinoma: rectal bleeding, disturbed bowel movement, weight loss not related to any diet within the last year, family cancer history.
Method: Detailed questionnaire on medical history, proctological examination and rectoscopy, and colonoscopy whenever the cause of bleeding was not identified.
Results: The following causes of bleeding were identified: grade II and grade III haemorrhoids in 55 patients, rectum/sigmoid polyps in 22 patients, anal fissure – 12 patients, inflammation of intestinal mucosa – 3 patients, rectal tumour – 3 patients, diverticular disease – 2 patients, rectal mucosal prolapse – 2 patients, tumour of the descending colon – 1 patient, rectal fistulas – 1 patient, vascular malformations – 1 patient, solitary rectal ulcer – 1 patient.
Conclusions: 1. Haemorrhoid bleedings may conceal symptoms of other diseases that are located at sites not covered by rectoscopy. 2. Bleedings are the most common reason for coming to a doctor by patients with proctological problems. 3. Haemorrhoids and anal fissure are the main causes of lower gastrointestinal bleedings. 4. 23.5% of patients taking part in the programme had no or delayed colonoscopy although it had been recommended by their referring doctors, which may indicate an inadequate level of medical education in this group of patients.

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