Audit on Patients Admitted with Fresh PR Bleeding Due to Non-Anal Causes

Aim: To audit the diagnoses, management and outcome of patients presenting with fresh PR bleeding due to non-anal causes.

Place and Duration: Emergency Surgical ward – National hospital Sri Lanka – 2019 November to 2020 October.

Methodology: All patients admitted with acute fresh PR bleeding were identified from patient records during this time period and based on final diagnosis, patients with anal causes, post-surgical/ polypectomy patients, known cancer patients and traumatic causes were excluded. Comorbidity, drop of haemoglobin, duration of hospital stay, imaging and colonoscopy findings, management and outcome data were collected from the records with patient consent.

Results: 18 patients were included in the study, and there were two [11.1%] patients with small bowel causes and 3 with no identified cause for the bleeding. Colitis was the commonest colonic cause of bleeding among the patients. CT and colonoscopy are complementary to each other in diagnosing the cause for bleeding with good diagnostic yield. Overall patients had good outcomes with conservative management and majority of patients [66.7%] were managed without blood transfusion. A drop of haemoglobin was the only factor shown significantly associated with a hospital stay [P< 0.003]. Age, comorbidities did not show such association.

Conclusion: Most of the time fresh bleeding due to colonic causes can be managed conservatively and non-colonic causes often need surgical intervention. A drop of haemoglobin is the main factor that determined the hospital stay.