Lower gastrointestinal bleeding at a referral hospital in Kigali, Rwanda: Clinical, colonoscopic and pathologic profiles
Background: In this study, lower gastrointestinal bleeding was defined as bleeding from gastrointestinal tract beyond the ligament of Treitz. It usually presents with hematochezia and melena depending on the site of bleeding. Most of the bleeding stops spontaneously, and colonoscopy remains the investigation of choice. Diverticulosis and angiodysplasia are the leading causes of bleeding in western countries and occur more commonly in the older population, but little is known about the epidemiology of lower gastrointestinal bleeding in Africa. The main objective of this study was to determine the epidemiological profile of lower gastrointestinal bleeding at one of the referral hospitals in Rwanda.
Methods: This cross-sectional observation study was conducted at Kigali university teaching hospital (CHUK). All patients who consulted the hospital with complaints of bleeding per rectum, and those referred for colonoscopy examination from District hospitals due to rectal bleeding, were cumulatively recruited into the study after providing informed consent, during the study period. Basic demographic data, clinical, colonoscopic and pathologic findings were collected and analyzed using Microsoft Excel. Ethical approval for the study was obtained from the University of Rwanda College of Medicine and Health Sciences’ Institutional review board and Hospital ethical committee.
Results: This study recruited 134 patient aged between 14 to 80 years with a median age of 47 years. Male to female ratio was 1.5:1. Most of the patients presented with subtle lower gastrointestinal bleeding; only 2 patients presented with massive bleeding. Hematochezia was the initial complaint in 81% of the patients; other complaints were melena and unexplained weight loss and anaemia in elderly people. Haemorrhoids, colorectal polyps and tumours were the leading causes of lower gastrointestinal bleeding identified in this study.
Conclusions: Lower gastrointestinal bleeding at CHUK was found in a relatively young and middle-aged population. Patients with massive bleeding requiring emergency evaluation were rare. The most common causes were haemorrhoids and colorectal tumours, suggesting the need for colonoscopy and biopsy in all patients presenting with the condition.