causes of minimal bright red bleeding per rectum in patients who referred to the gastroenterology clinic of loghman hakim hospital (september 2003-march 2006)

background: minimal bright red bleeding per rectum (mbrbpr) is a common complaint in adult patients. most studies have not been performed in patients with strictly minimal brbpr, and there are no evidence-based recommendations for this group of patients. materials and methods: patients with complaints as small amounts of red blood after wiping or a few drops of blood in the toilet bowl after defecation not intermixed with stool were consecutively enrolled. those with a history of inflammatory bowel disease, colorectal cancer, adenomatous polyps, significant weight loss, anemia, strong family history of colorectal cancer and not consenting for colonoscopy were excluded. patients underwent total colonoscopy or rectosigmoidoscopy plus double contrast barium enema (age›40) or a minimum of rectosigmoidoscopy (to the splenic flexure in patients aged ‹ 40). results: two-hundred twenty patients were eligible in the study period. normal findings were found in 23 (10.5%). there was at least one distal lesion in the remaining patients. from 11 patients with a proximal lesion, 10 had the same lesion in distal colon and there was only one patient with an adenomatous polyp near the hepatic flexure and hemorrhoids. in patients with anorectal pathologies (n=189), there was a concomitant colonic lesion in 25 (13.2%). all patients with clinically significant lesions (ibd, polyp or cancer) located over 30 cm from anus were aged more than 40 years. conclusion: the causative lesions for mbrbpr are located in the distal colon. rectoscopy (40 years or less) or flexible rectosigmoidoscopy (over 40 years) seem to be the appropriate evaluation in these patients.