Rectal Bleeding Unit

1) Minor rectal bleeding

Rectal bleeding is a very important symptom.
With the Rectal Bleeding Unit the Hospitals might be more close to the general practitioners and to the population; infact in this way they permit easier and rapid diagnosis and treatment of these symptoms.
What does rectal bleeding mean? The rectal bleeding is a lost of blood from the anus.
This can be minor chronic or major acute. The blood can be red as if it comes from a blessure or dark red as the old blood with clots.The latter blood has lost the oxygen and it contains much carbonic acid. The red blood can comes from the anorectum and from all the left colon.
The clots and the dark red blood come generally from stomach and upper g.i. tract.
From the right colon blood comes very rarely macroscopically,we generally have occult positive test that indicates a lesion.
The presence of mucous observed in the toilet is also very important.
Because of this in the colorectal cancer prevention, one of the most important goals is to explain to the people how is important to observe the stool in the toilets daily and observe the presence of blood or mucous.It is also very important to explain to the people that two pathologies like haemorrhoids and cancer can coexist.
The rectal bleeding unit therefore must be the point of reference for these patients.
In the R.B.U. thank a correct clinic history of the patient with symptoms,the patient will be submitted to the correct examinations,belonging to the age,the symptoms,and the family history.
For this reason we will do only the investigations that will be necessary,so the waiting list will be reduced on time and the treatment will be exactly fired to the symptom.
This is the real prevention of colorectal cancer; infact we will treat the symptomatic patients more rapidly.
Even if the asyptomatic patient will underwent to the screening the R.B.U. will treat the symptomatic population with a risk of cancer much more elevated. The R.B.U.allows to make the diagnosis also because can perform quickly a left colonoscopy( which is done normally in the screening on asymptomatic patients) in all the patients with high risk for colorectal cancer(age,family history,and predisponent diseases) who are symptomatic for bleeding.
This unit presents many difficulties to start obviously because it is managed by surgeons and it is against the actual sanitaris system actally present in Europe where the gastroenterologists are the leaders of the endoscopy and the colorectal screening.
For this reason first of all we must have an agreement with the gastroenterologist to start the unit.
Not only the gastroenterologists are important but also the pathologists, radiologists and the oncologists. That’s why it must be multidisciplinary.

2) Major acute rectal bleeding

The rectal bleeding unit must treat also the major rectal bleeding. This mean that the great loss of blood from anus can be acute and followed by shock of the patient.
These patients need to go to an emergency department to be stabilized first of all and then they have to be followed by a colorectal surgeon with a gastroenterologist, a radiologist who perform arteriography, ct scan, and scintigraphy.
In fact between the diagnostic exames to do we have colonoscopy, anoscopy, ct scan, arterography, scintigraphy with labelled RBC.
In the patients with major rectal bleeding these diagnostic techniques can also permit to perform a therapeutic procedure, often without a surgical operation.
In this way the operation ,if necessary, will be done later with less risk for the patient.
The ct scan, the arteriography the scintigraphy permit a quick diagnosis and a rapid treatement. In particular the MDCT permit a diagnosis in 95% of cases in all the emergency patients.
The rectal bleeding team well organized is on call for 24 hours per day and it is already been experienced at the Mayo Clinic of Rochester. Now we are trying to organize it at the S.Giovanni Battista Hospital of Turin.
This Unit will reduce the risk of mortality in these patients and will permit to use in the best way the resources of the Hospital.

Dr. Edoardo Formento
Dr. Elisabetta Radice

Unità di sanguinamento rettale
Ospedale Molinette
Dipartimento di Fisiopatologia Chirurgica
Università di Torino
Via Genova 2
Torino.

edfor@libero.it
Elisabetta.radice@unito.it