Colonoscopy in Elderly Patients with Hemorrhoidal Disease and Average-Risk for Colorectal Cancer, a Qatari Community Hospital Experience


Introduction: Hemorrhoids are a frequent and familiar concern of patients in the general practice and surgery settings. Colonoscopy is both diagnostic and therapeutic. In Qatar, There are little data available about coincidental pathology in elderly patients with hemorrhoids. Objective: To assess the outcome of colonoscopy in management patients with hemorrhoidal disease and average-risk for colorectal cancer and its clinical significance. Method: A retrospective study of 200 patients with hemorrhoids with average risk colorectal cancer (anal bleeding and anal symptoms) and subjected to colonoscopic examination at Al Khor hospital’s endoscopy unit during the period from May 2005 till August 2012. Patients below 50 years and high risk patients for colorectal cancer; with the following alarm signs: Positive personal history of colorectal neoplasms or Inflammatory Bowel Disease (IBD), positive first degree family history of colorectal neoplasms, history of altered bowel habits, recent significant weight loss, presence of iron deficiency anemia, and history of previous colonoscopy were excluded. All significant endoscopic co-findings (diverticuli, polyps, cancer, angiodysplasia and varices, or colitis) were recorded. Results: There were 200 patients; 134 male, 66 female; Mean patient age was 56.3 years (range, 50 to 82 years), who met the eligibility criteria. 200 colonoscopies were performed. Evaluation of these patients revealed Polyps in 16 patients (13 benign and 3 malignant), seven malignant lesions(one annular lesion and 6 fungating masses), Ulcerative colitis in 5 patients, no crohn’s disease, diverticular disease in 4 patients, no Vascular malformations, bleeding piles in 3 patients controlled by injection, and 65.5% of patients were free from any additional pathology. Colonoscopy changed the treatment plan in 58 patients (29%). No complications were encountered. Conclusion: Coincidental abnormalities in colon and rectum in elderly patients with hemorrhoids are common. Benign polyps, followed by diverticular diseases, anal fissures then colorectal cancer were the commonest findings. Endoscopic evaluation of elderly patients with hemorrhoids and average risk for colorectal cancer is advocated. Omitting endoscopy in these patients can lead to major doctors’ delay.

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H. Hennawy, A. Badi and A. Basheer, "Colonoscopy in Elderly Patients with Hemorrhoidal Disease and Average-Risk for Colorectal Cancer, a Qatari Community Hospital Experience," Surgical Science, Vol. 3 No. 12, 2012, pp. 576-579. doi: 10.4236/ss.2012.312114.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] J. F. Johanson and A. Sonnenberg, “The Prevalence of Hemorrhoids and Chronic Constipation. An Epidemiologic Study,” Gastroenterology, Vol. 98, No. 2, 1990, pp. 380-386.
[2] S. Lorenzo-Rivero, “Hemorrhoids: Diagnosis and Current Management,” The American Surgeon, Vol. 75, No. 8, 2009, pp. 635-642.
[3] R. Vanheuverzwyn, J. F. Colin, T. van Wymersch, A. Kartheuser and P. Hoang, “Hemorrhoids,” Review, Acta Gastroenterol Belg, Vol. 58, No. 5-6, 1995, pp. 452-464.
[4] J. L. Pfenninger and G. G. Zainea, “Common Anorectal Conditions: Part I. Symptoms and Complaints,” American Family Physician, Vol. 63, No. 12, 2001, pp. 2391-2398.
[5] R. Lawrenson, J. Logie and C. Marks, “Risk of Colorectal Cancer in General Practice Patients Presenting with Rectal Bleeding, Change in Bowel Habit or Anaemia,” European Journal of Cancer Care, Vol. 15, No. 3, 2006, pp. 267-271. doi:10.1111/j.1365-2354.2005.00637.x
[6] F. Pigot, “Haemorrhoidal Disease,” Revue du Praticien, Vol. 58, No. 16, 2008, pp. 1763-1768.
[7] M. D. Elizabeth-Allen, M. D. Christina-Nicolaidis, Mark and M. D. Helfand, “The Evaluation of Rectal Bleeding in Adults a Cost-Effectiveness Analysis Comparing Four Diagnostic Strategies,” Journal of General Internal Medicine, Vol. 20, No. 1, 2005, pp. 81-90. doi:10.1111/j.1525-1497.2005.40077.x
[8] W. Hamilton and D. Sharp, “Diagnosis of Colorectal Cancer in Primary Care: The Evidence Base for Guidelines,” Family Practice, Vol. 21, No. 1, 2004, pp. 99-106. doi:10.1093/fampra/cmh121
[9] O. S. Lin, R. A. Kozarek, D. B. Schembre, K. Ayub, M. Gluck, F. Drennan, M.-S. Soon and L. Rabeneck, “Screening Colonoscopy in Very Elderly Patients Prevalence of Neoplasia and Estimated Impact on Life Expectancy,” The Journal of the American Medical Association, Vol. 295, No. 20, 2006, pp. 2357-2365.
[10] M. V. Koning and R. J. L. F. Loffeld, “Rectal Bleeding in Patients with Haemorrhoids, Coincidental Findings in Colon and Rectum,” Family Practice, Vol. 27, No. 3, 2010 pp. 260-262. doi:10.1093/fampra/cmq008
[11] M. V. Koning and R. J. L. F. Loffeld, “A Survey of Abnormalities in the Colon and Rectum in Patients with Haemorrhoids,” BMC Gastroenterology, Vol. 10, No. 74, 2010, p. 74. doi:10.1186/1471-230X-10-74
[12] R. F. Wong, R. Khosla, J. H. Moore and S. K. Kuwada, “Consider Colonoscopy for Young Patients with Hematochezia,” The Journal of Family Practice, Vol. 53, No. 11, 2004, pp. 879-884.
[13] S. Nikpour and A. Asgari, “Colonoscopic Evaluation of Minimal Rectal Bleeding in Average-Risk Patients for Colorectal Cancer,” World Journal of Gastroenterology, Vol. 14, No. 42, 2008, pp. 6536-6540. doi:10.3748/wjg.14.6536
[14] A. Jemal, R. Siegel, E. Ward, et al., “Cancer Statistics,” CA: A Cancer Journal for Clinicians, Vol. 58, No. 2, 2008, pp. 71-96. doi:10.3322/CA.2007.0010

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