DIFFERENTIAL DIAGNOSIS OF BLEEDING PER RECTUM AND AYURVEDIC STYPTIC MEASURES: A REVIEW

A greater part of the population has experienced rectal bleeding at any stage of their life span. Bleeding per rectum is the commonest but alarming symptom of all the anorectal complaints of the patients attending OPDs. Many of the general practitioners involved in rural areas, detain per rectal and proctoscopic examination of anorectal primary care patients, consequently, most of the serious illnesses may forego undiagnosed and could become life-threatening and economically overburden the patient. Differential diagnosis plays a key role in treating effectively. Ayurvedic literature has accredited several diseases with symptoms of bleeding per rectum. In most of the pittaja and raktaja variety of pakvashayagata (related to the colon) and gudagata rogas (related to anus & rectum), bleeding per rectum is the commonest symptom. The literature has given the number of etiological factors and many ailments causing bleeding per rectum such as age, habitat, food habits, occupation, and habits. Detailed history regarding these and nature of bleeding, amount of bleeding, colour etc. may certainly help to differentiate the diseases. This article highlights disease wise features and nature of bleeding, recommended investigations and colonoscopic examination which will differentiate and confirm the diagnosis. And also lists out several Ayurvedic styptic medicines which facilitate the cessation of bleeding when used judiciously according to dosha and vyadhi avastha.

Histopathological study of endoscopic biopsies of large intestine

The large intestine is a site of a variety of diseases. The lesions tend to occur affecting different age groups ranging from early childhood to late adulthood. Patients may present with very vague clinical symptoms ranging from abdominal pain, loose stools, vomiting, diarrhoea, bleeding per rectum, and change in bowel habit. Patients presenting with repeated symptoms related to lower intestinal pathology are advised to undergo colonoscopic examination.To study clinico-pathological correlation of endoscopic biopsies of large intestine and to study spectrum of large intestinal lesions.The study was conducted at a tertiary care hospital from August 2018 to July 2020. All endoscopic biopsy samples were included in this study. All endoscopic biopsies were performed by high definition colonoscope. Clinical and endoscopic correlation with histopathological diagnosis was performed and results were generated.Total 133 cases were included in this study, out of 133 patients 86 were males and 47 were females. Patients showed wide age range from 11 years to 80 years. There were 25 patients each in age group of 31-40 years and 61-70 years. The most common presenting complaint was loose stools in 66 cases. The most common endoscopic finding was erythema in 82 cases. Out of 133 cases, 105 cases were non neoplastic, 08 cases were benign neoplastic and 20 cases were malignant neoplastic on histopathology.Colonoscopy is very high yielding and safe procedure to perform.Colonoscopic biopsies are proven to be of great importance. Clinical, endoscopic and histopathological correlation is always advisable in large intestinal pathology for early diagnosis and treatment.

Clinical Profile and Colonoscopic Findings in Patients Presented with Lower Gastrointestinal Bleeding in UCMS

INTRODUCTION The lower gastrointestinal bleeding (LGIB) is an alarming symptom and common disease with annual admission of 0.15% with mortality rate of 5-10%. LGIB is caused by neoplastic and non-neoplastic lesions. For accurate diagnosis of various colorectal lesions, colonoscopy is gold standard, convenient and cost effective procedure. It is the investigation of choice in LGIB and helps in early diagnosis of colorectal carcinoma. This study was aimed to scrutinize the clinical and colonoscopic findings in patients with LGIB in UCMS. MATERIAL AND METHODS This was a hospital based prospective observational study conducted after taking permission from institutional review committee in January 2017 at UCMS-TH from 15th January 2017 to 15th January 2018. All patients presenting with LGIB who fulfilled inclusion and exclusion criteria and gave written consent were included. RESULTS Total 88 patients were included in the study. The mean age of our patients was 48 ±17 years with age range from 17-81 years. Majority were in the age group 50-60 years (25%) (n=22). Colonoscopy detected abnormality in 73.8% cases. The common non-neoplastic were haemorrhoids and non-specific colitis (14.5% each) followed by 12.5% of neoplastic cases. The higher frequency of colorectal lesions was observed in males comprising 72.7% (n=64) patients. The most commonly diagnosed etiologies of LGIB were haemorrhoid and nonspecific colitis respectively. CONCLUSION Colonoscopy detected abnormality in 75% of cases. The common causes of LGIB were haemorrhoids and non-specific colitis followed by neoplastic lesion. A careful history, physical and colonoscopic examination with or without biopsy makes significant impact for early diagnosis and treatment.

Transperineal total mesorectal excision for rectal cancer on the residual rectum after multiple abdominal surgeries in a patient with Crohn’s disease: a case report

Background The improved prognosis of Crohn’s disease may increase the opportunities of surgical treatment for patients with Crohn’s disease and the risk of development of colorectal cancer. We herein describe a patient with Crohn’s disease and a history of multiple surgeries who developed rectal stump carcinoma that was treated laparoscopically and transperineally. Case presentation A 51-year-old man had been diagnosed with Crohn’s disease 35 years earlier and had undergone several operations for treatment of Crohn’s colitis. Colonoscopic examination was performed and revealed rectal cancer at the residual rectum. The patient was then referred to our department. The tumor was diagnosed as clinical T2N0M0, Stage I. We treated the tumor by combination of laparoscopic surgery and concomitant transperineal resection of the rectum. While the intra-abdominal adhesion was dissected laparoscopically, rectal dissection in the correct plane progressed by the transperineal approach. The rectal cancer was resected without involvement of the resection margin. The duration of the operation was 3 h 48 min, the blood loss volume was 50 mL, and no intraoperative complications occurred. The pathological diagnosis of the tumor was type 5 well- and moderately differentiated adenocarcinoma, pT2N0, Stage I. No recurrence was evident 3 months after the operation, and no adjuvant chemotherapy was performed. Conclusion The transperineal approach might be useful in patients with Crohn’s disease who develop rectal cancer after multiple abdominal surgeries.

COLONOSCOPIC EXAMINATION PROFILE AT THE UKI HOSPITAL, EAST JAKARTA FROM JANUARY 2014 - JULY 2015

Colonoscopy is a procedure, which is done using a Colonoscope. The technique implemented in evaluating the colon: Picture of the colon, derived from the computed tomography or magnetic resonance imaging, is processed (reconstructed) by the computer to reveal colon lumen in 3D. Colonoscopy is used to diagnose diseases found in the large intestine; however, not all kinds of ailments in the large intestine can be diagnosed by colonoscopy. This study aims to determine the colonoscopy procedure profile in UKI Hospital East Jakarta from 2014 to July 2015. The design used by this research is a descriptive study, which is retrospective to the population of patients that have had a colonoscopy in UKI Hospital from January 2014 to July 2015. This study reveals the colonoscopy procedure profile at UKI Hospital, East Jakarta from January 2014 to July 2015: the most dominant age of the patients receiving colonoscopy is between 50 and 59. Patients are males of Batak ethnicity with a background of high school education. These males' main symptom is abdominal pain, which leads to colitis infection as the primary diagnosis. This study shows that patients who have the colonoscopy done upon them are patients with the age span of 50–59. Most are males due to the factor of lifestyle and stress condition. Background of the patients is working males with high school diplomas. The main complaint found among these patients is abdominal pain. Colitis infection is found to be the primary diagnosis among them.

Histopathology of Polyps and Its Clinical Correlation in Sample of Iraqi Patients Undergoing Colonoscopic Examination

BACKGROUND /AIMS: Colorectal cancer is the third most common cancer in 2018, the objective of our study was to describe the types and patterns of colorectal polyps in patients presenting to a tertiary care referral center in Baghdad. We also assessed the polyp detection rate (PDR) and adenoma detection rate (ADR). PATIENTS & METHODS: This is single-institution, descriptive cross-sectional study of consenting 103 patients who had colonoscopy done at the Endoscopy Unit of Baghdad teaching hospital, IRAQ from the 1st of June 2018 to 31st of March 2019 after taking verbal consent, The data collected included: Age, sex, Family history of colorectal malignancies and indication for the current colonoscopy. RESULTS: One thousand and thirty patients were included in the study with a mean age of 44 years (SD = 16), with 560 males representing 54.4% and 470 females representing 45.66%.The polyp detection rate in colonoscopies was 19.4% and the adenoma detection rate was 13.6%. Polyps were found and removed in 200 patients, 40% of the removed polyps were tubular adenomas, tubulovillous adenomas in 20%, villous adenomas in 10%, hyperplastic polyps in 5%. The majority of the polyps were in the distal colon in 80% of patients with polyps. CONCLUSIONS: The polyp detection rate was (19.4%) and adenoma detection rate was (13.6%). The majority of polyps were detected in distal colon.

ASSESSMENT OF SEVERITY OF ULCERATIVE COLITIS ON FIRST COLONOSCOPIC EXAMINATION

Objective: To assess the severity of ulcerative colitis on first colonoscopic examination. Study Design: Prospective cross-sectional (correlational) study design. Place and Duration of Study: Study was conducted in Gastroenterology Outpatient Department of Pak Emirates Military Hospital, Rawalpindi, from Nov 2017 to Oct 2018. Methodology: An aggregate of 200 patients within the age range of 12-70 years, were included in the studythrough non-probability consecutive sampling. The data was collected by the self-administered questionnaireincluding age, gender, stool frequency, P/R bleed, systemic features of ulcerative colitis & colonoscopic findings.Effectiveness of the procedures was noted on a pre-designed performa and the endoscopic assessment was based upon mayo score severity of colitis graded from Normal (0) to Severe (3). Data was analyzed by using SPSS-19. Results: The mean age of the participants was reported 38 ± 2.1 years. Out of 200 participants 104 (52%) weremale, diarrhea with PR bleed was positive in 180 (90%) & anemia in 154 (77%). Colonoscopic findings showedthat 72 (36%) were with Left sided colitis (Montreal Class E2) & 82 (41%) with proctitis (Montreal class E1). Severe disease (Mayo endoscopic Score 3) was positive in 118 (59%) patients. Conclusion: Assessment of severity of UC is important as it determines the long term management & alsovaluable for risk stratification to predict the prognosis. Our findings feature the requirement for system levelenhancements to encourage the proper delivery of colonoscopy services dependent on individual risk. Keywords: , , , .

A Case of Large Bowel Obstruction- An Unusual Cause in a Middle Aged Female

Endometriosis is a disease seen among women in reproductive age group. It is characterised by deposition of endometrial tissue outside the uterus. It commonly involves the pelvic organs like ovary, fallopian tube and pelvic ligaments. Involvement of gastrointestinal tract by endometriosis is uncommon and the incidence varies widely among different studies. Colonic endometriosis can be confused as malignancy both clinically and radiologically. In these instances, histopathology is essential for a correct diagnosis. Here, the authors report a case of colonic endometriosis presenting with features of large bowel obstruction in a 49-year-old female with previous history of laparoscopic hysterectomy. Radiological scanning of abdomen and colonoscopic examination were suspicious of sigmoid malignancy. Although colonic biopsy was inconclusive and tumour markers were normal, she underwent sigmoidectomy with lymphnode clearance as per oncological principles with primary anastomosis. Her final histopathological examination revealed features of colonic endometriosis without any evidence of malignancy. Detailed evaluation of the patient didn’t reveal endometriosis at any other site. Patient was discharged after full surgical recovery and was doing well till the last follow-up.

Automated Classification of Colorectal Neoplasms in White-Light Colonoscopy Images via Deep Learning

Background: Classification of colorectal neoplasms during colonoscopic examination is important to avoid unnecessary endoscopic biopsy or resection. This study aimed to develop and validate deep learning models that automatically classify colorectal lesions histologically on white-light colonoscopy images. Methods: White-light colonoscopy images of colorectal lesions exhibiting pathological results were collected and classified into seven categories: stages T1-4 colorectal cancer (CRC), high-grade dysplasia (HGD), tubular adenoma (TA), and non-neoplasms. The images were then re-classified into four categories including advanced CRC, early CRC/HGD, TA, and non-neoplasms. Two convolutional neural network models were trained, and the performances were evaluated in an internal test dataset and an external validation dataset. Results: In total, 3828 images were collected from 1339 patients. The mean accuracies of ResNet-152 model for the seven-category and four-category classification were 60.2% and 67.3% in the internal test dataset, and 74.7% and 79.2% in the external validation dataset, respectively, including 240 images. In the external validation, ResNet-152 outperformed two endoscopists for four-category classification, and showed a higher mean area under the curve (AUC) for detecting TA+ lesions (0.818) compared to the worst-performing endoscopist. The mean AUC for detecting HGD+ lesions reached 0.876 by Inception-ResNet-v2. Conclusions: A deep learning model presented promising performance in classifying colorectal lesions on white-light colonoscopy images; this model could help endoscopists build optimal treatment strategies.