Investigating rectal bleeding

doi:10.1136/bmj.39379.598090.AD

BMJ 2007;335:1260-1262 (15 December), doi:10.1136/bmj.39379.598090.AD

Practice

Rational Imaging

Investigating rectal bleeding

David Burling, consultant gastrointestinal radiologist ¹, James E East, research fellow in endoscopy ², Stuart A Taylor, senior lecturer³

¹ Intestinal Imaging Centre, St Mark’s Hospital, Harrow HA1 3UJ, ² Wolfson Unit for Endoscopy, St Mark’s Hospital, ³ Department of Specialist Radiology, University College Hospital, London NW1 2BU

Correspondence to: D Burling burlingdavid@yahoo.co.uk

Conventional colonoscopy is considered the optimal investigationfor rectal bleeding; however, this article explores the useof virtual colonoscopy as a new investigative technique

The first 150 words of the full text of this article appear below.

Learning points

Conventional colonoscopy is considered theoptimal procedure for investigating rectal bleeding and is theonly investigation that allows tissue removal, is widely available,and does not involve radiation
For some patients, virtual colonoscopymay be preferable as it is minimally invasive and convenientfor patients and may also provide additional extracolonic information
Diagnosticvirtual colonoscopy and therapeutic endoscopy can be complementarytechniques
Close collaboration between endoscopy and radiologystaff enables same day (single visit) virtual colonoscopy andconventional colonoscopy

The patient

An 83 year old man was referred to a surgical outpatient clinicby his general practitioner via the "two week wait" bowel cancerpathway for patients with persistent rectal bleeding (painlessdark red blood with clots per rectum for one month with bloodmixed in the stool) but no anal symptoms. He had had no weightloss or change in bowel habit, and except for hypertension,he was a fit non-smoker . . . [Full text of this article]