Rectal bleeding and melena are classical alarm symptoms that warrant colonoscopic evaluation to exclude colorectal neoplasia and other organic lesions. However, the diagnostic value of colonoscopy in this setting may vary according to patient profile and local practice. We aimed to describe colonoscopic findings in patients undergoing colonoscopy for lower gastrointestinal bleeding.

We conducted a retrospective study including only adult patients who underwent colonoscopy for lower gastrointestinal bleeding (rectal bleeding and/or melena) at Sahloul University Hospital. Demographic data, indications and endoscopic findings were extracted from colonoscopy reports. The main lesions of interest were colorectal polyps, colorectal tumors, diverticulosis, angiodysplasia and hemorrhoids. The diagnostic value of colonoscopy was expressed as the proportion of procedures in which each lesion type was identified.

A total of 48 colonoscopies performed for lower gastrointestinal bleeding were included. Colorectal polyps were detected in approximately 31% of examinations, and colorectal tumors in about 6%. Diverticulosis was observed in nearly one quarter of patients, and angiodysplasia in around 6% of cases.Hemorrhoids were particularly frequent, identified in almost one out of five patients, representing a substantial proportion of likely or contributory causes of bleeding. Most colonoscopies were complete, allowing full colonic evaluation in the majority of cases and accurate characterization of the underlying etiology of bleeding.

In this cohort of patients undergoing colonoscopy specifically for lower gastrointestinal bleeding, nearly one third had colorectal polyps, a non-negligible proportion had colorectal cancer, and hemorrhoidal disease was very commonly identified. These findings confirm the high diagnostic value of colonoscopy in the setting of lower gastrointestinal bleeding and highlight hemorrhoids, alongside neoplastic and diverticular lesions, as major etiologies. They support colonoscopy as a first-line investigation in this clinical context.