Consider colonoscopy for young patients with hematochezia.
BACKGROUND
Hematochezia is a common complaint in adult patients aged <50 years. Most studies of lower endoscopy for rectal bleeding have concentrated on older patients or have failed to mention the location of lesions.


OBJECTIVE
To determine the findings of complete colonoscopy in adults younger than 50 years with rectal bleeding.


METHODS
Data were retrieved from medical records and included demographics, indications, endoscopic findings, and histology. Lesions were labeled according to location: proximal to the splenic flexure or distal to (and including) the splenic flexure. Excluded were those with a history of colitis, colorectal cancer, polyps, anemia, significant weight loss, severe bleeding, or strong family history of colorectal cancer.


RESULTS
The study included 223 patients with rectal bleeding aged <50 years who had undergone a colonoscopy. Normal findings were recorded for 48 (21.5%). Four (1.8%) were diagnosed with cancer in the distal colon, and 22 (9.9%) were found to have colon adenomas, 6 of whom had proximal adenomas only. Hemorrhoids were present in 135 patients (60.5%). Other findings included colitis, angiodysplasia, diverticulosis, anal fissures, and rectal ulcers.


CONCLUSIONS
Colon neoplasms may be present even in younger adults with nonurgent rectal bleeding. Though most findings were benign and located in the distal colon, colonoscopy should be strongly considered for this patient group.
Wong
Robert F
RF
Division of Gastroenterology, 4R-118 SOM, University of Utah Medical Center, 50 North Medical Drive, Salt Lake City, UT 84132, USA.
Khosla
Rajan
R
Moore
John H
JH
Kuwada
Scott K
SK
D000236:Adenoma / Q000150:complications / Q000175:diagnosis; D000328:Adult; D000367:Age Factors; D016888:Angiodysplasia / Q000150:complications / Q000175:diagnosis; D003092:Colitis / Q000150:complications / Q000175:diagnosis; D003108:Colonic Diseases / Q000150:complications* / Q000175:diagnosis*; D003110:Colonic Neoplasms / Q000150:complications / Q000175:diagnosis; D003113:Colonoscopy / Q000379:methods; D004241:Diverticulum, Colon / Q000150:complications / Q000175:diagnosis; D005260:Female; D005401:Fissure in Ano / Q000150:complications / Q000175:diagnosis; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D006484:Hemorrhoids / Q000150:complications / Q000175:diagnosis; D016558:Hemostasis, Endoscopic; D006801:Humans; D007417:Intestinal Polyps / Q000150:complications / Q000175:diagnosis; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D012002:Rectal Diseases / Q000150:complications* / Q000175:diagnosis*; D012189:Retrospective Studies; D012307:Risk Factors; D014456:Ulcer / Q000150:complications / Q000175:diagnosis; D014481:United States / Q000453:epidemiology