Abstract

Introduction and aim: Lower Gastrointestinal (GI) bleeding is not well documented in Chad despite its frequency. The aim of this work was to study patients with lower GI bleeding, as well as the lesions attributable to this bleeding.

Patients and method: This was a retrospective, descriptive and analytical study carried out at the Internal Medicine department from January 1, 2015 to October 30, 2020. The medical records of patients who performed a complete colonoscopy for hematochezia have been included. Epidemiological, clinical, biological and endoscopic data were collected.

Results: in term of frequency lower GI bleeding constitutes 21.6% (120/555) of the reasons for requesting a colonoscopy. The mean age of patients with lower GI bleeding was 44 ± 15 years; the median of 42 years (5-78 years) and the modal class of 36-55 years (35%); the sex ratio was 4. The mean duration of the development of hematochezia was 1 year ± 2.9 years (range 3 days and 30 years); the amount of bleeding was low in 76.7% of cases (n = 92). They occurred post-fecal in 43.3% (n = 52) of cases; associated with constipation (26%; n = 31), proctalgia (20%; n = 24) and altered general status (10%; n = 12). Severe anemia was present in 4.3% (n = 4). The anoscopy, performed in 60% of patients, and was abnormal in 50.8% of cases (n = 61). Hemorrhoids (56.6%; n = 61) and colitis (27.8%; n = 30) were the most listed lesions. Patients less than 44 years of age had significantly anal fissure (p = 0.02); those over 44 years had colonic diverticula (p = 0.027) or colorectal cancer (p = 0.001). Hemorrhoids and colorectal cancer were more common in men (p = 0.033) all cancer patients had anemia (p= 0.001). Cancers (100%; n = 9), colitis (93.3%; n = 28) and anal fissures (75% n = 12) were the three main lesions attributed to hematochezia.

Conclusion:Lower GI bleeding, usually well tolerated, was frequent in gastrointestinal endoscopic exploration in young adult men without comorbidity. The cost-effectiveness of colonoscopy associated with anoscopy was high. Colorectal cancer was found in 8.3% of cases.

Keywords: Lower gastrointestinal bleeding; Etiology; Epidemiology; Clinic; Chad