Contribution of Lower Digestive Endoscopy to the Diagnosis of Hematochezia: A Report of 811 Cases at the General Hospital Idrissa Pouye (Dakar, Senegal)

Abstract

Introduction: Haematochezia is defined as the emission of red blood from the anus. It most often reflects lower digestive haemorrhage (LDH), i.e. , bleeding originating downstream of Treitz’s angle. Nowadays, with improved techniques for exploring the small intestine (video capsule, enteroscopy), some authors consider HDB to be bleeding originating downstream of Bauhin’s valve. In sub-Saharan Africa, particularly Senegal, the available data on lower digestive haemorrhage and its aetiologies are patchy, segmental and few in number. The aim of our study was to determine the contribution of lower digestive endoscopy to the diagnosis of haematochezia. Methodology: This was a retrospective descriptive and analytical study carried out between January 2015 and December 2022 in the digestive endoscopy centre of the Idrissa Pouye General Hospital. We collated all rectosigmoidoscopy and colonoscopy reports for which the indication was haematochezia. We excluded reports with incomplete data concerning patient age, sex or endoscopic examination results. The data were entered and analysed using Sphinx version 5.1.0.2 and SPSS (Statistical Package for Social Sciences) version 18. Cross-tabulations were used for the analytical study. To compare frequencies, we used Pearson’s Chi-square test or Fisher’s two-tailed exact test, depending on their applicability. Means were compared using the analysis of variance test with a significance threshold of p < 0.05. Results: The endoscopic prevalence of haematochezia was 36%. The mean age was 47 years, with extremes ranging from 1 to 92 years. The sex ratio was 1.74 (515 men). Haematochezia was mainly associated with constipation (33.6%), proctalgia (21.7%), diarrhoea (13.6%), and a change in general condition (11.3%). 88 patients (10.8%) had normal endoscopy. One or more lesions were found in 723 patients (89.2%). The main lesions found were related to haemorrhoidal disease (47.6%), polyps (10%), neoplastic lesions (9.5%), diverticulosis (8.3%), haemorrhagic rectocolitis (4.2%), solitary rectal ulcer (2.5%), angiodysplasia (1.2%), Crohn’s disease (1%), radiation rectitis (0.7%) and ischaemic colitis (0.4%). Neoplastic lesions. Squamous cell carcinoma was the histological type in all cases of anal cancer, and adenocarcinoma accounted for 91.6% of colorectal neoplasia. Conclusion: Haematochezia has a variety of aetiologies, most of which can be diagnosed using lower digestive endoscopy. At the HOGIP digestive endoscopy centre, HDB mainly affects young adults, with a predominance of men. Haemorrhoidal disease and tumour lesions are the main causes.