Surgical Science, 2012, 3, 576-579 http://dx.doi.org/10.4236/ss.2012.312114 Published Online December 2012 (http://www.SciRP.org/journal/ss) Colonoscopy in Elderly Patients with Hemorrhoidal Disease and Average-Risk for Colorectal Cancer, a Qatari Community Hospital Experience Hany M. El Hennawy 1 , Ahmed M. Badi 2 , Alaa Eldin A. Basheer 2 , Ibrahem M. El Omari 3 1 Department of General Surgery, Al Khor Hospital, Hamad Medical Corporation, Doha, Qatar 2 Department of Medicine, Al Khor Hospital, Hamad Medical Corporation, Doha, Qatar 3 Department of Geriatric Medicine, Al Amal Hospital, Hamad Medical Corporation, Doha, Qatar Email: hennawyhany@hotmail.com Received September 22, 2012; revised October 24, 2012; accepted November 4, 2012 ABSTRACT 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 hemor- rhoidal 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. Pa- tients below 50 years and high risk patients for colorectal cancer; with the following alarm signs: Positive personal his- tory 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 his- tory of previous colonoscopy were excluded. All significant endoscopic co-findings (diverticuli, polyps, cancer, angio- dysplasia 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. Evalua- tion 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 encoun- tered. 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. En- doscopic 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. Keywords: Colonoscopy; Elderly; Hemorrhoidal Disease; Colorectal Cancer 1. Introduction Hemorrhoids are a common surgical problem and affect about 4 percent of population [1] Symptomatic hemor- rhoids affect at least 50% of the American population at some time during their lives, with around 5% of the population suffering at any given time, and both sexes experiencing the same incidence of the condition [2]. The aetiopathogenesis remains unclear. Progressive degenera- tion of the fibromuscular structure of the internal hemor- rhoidal plexus may be the reason [3]. Many other ab- normalities in the rectum and colon can be responsible for rectal bleeding [4]. The relationship between rectal bleeding and colorectal cancer has been studied. How- ever, the relationship between rectal bleeding, hemor- rhoids and other pathology is not clear. Rectal bleeding is one of the commonest symptoms of colorectal cancer, but more often, it is because of benign pathology. It is generally regarded as a symptom of early colorectal can- cer. Rectal bleeding of any nature in primary care is con- sidered a “mandatory referral symptom”, requiring in- vestigation in secondary care [5]. Rectal bleeding in pa- tients with hemorrhoids requires exact diagnosis because it may be not simply a hemorrhoidal bleeding and can be an early sign of severe bowel diseases, such as colon car- cinoma, or inflammatory bowel diseases that could be discovered by colonoscopy [6]. Age is the number one risk factor for colorectal cancer. More than 90% of peo- ple diagnosed with the disease are 50 or older and the Copyright © 2012 SciRes. SS