eMedicine Specialties > Emergency Medicine > Gastrointestinal

Proctitis: Differential Diagnoses & Workup

Author: Lisandro Irizarry, MD, MPH, FAAEM, Chair, Department of Emergency Medicine, Brooklyn Hospital Center; Assistant Professor, Department of Emergency Medicine, Weill Cornell School of Medicine
Coauthor(s): Ibis Yarde, MD, Staff Physician, Department of Emergency Medicine, Brooklyn Hospital Center
Contributor Information and Disclosures

Updated: Apr 27, 2009

Differential Diagnoses

Anal Fistulas and Fissures
Herpes Simplex
Chancroid
HIV Infection and AIDS
Clostridium difficile colitis/proctitis
Inflammatory Bowel Disease
Diverticular Disease
Lymphogranuloma Venereum
Foreign Bodies, Rectum
Syphilis
Gonorrhea
Vulvovaginitis

Other Problems to Be Considered

Traumatic proctitis
Infections (eg, shigellosis, amebiasis)

Workup

Laboratory Studies

  • A complete blood count (CBC) is performed to evaluate for chronic or severe blood loss.
  • A sequential multiple analysis of 7 serum tests (SMA 7) is performed to evaluate for severe electrolyte/fluid losses or to look for evidence of renal insufficiency prior to initiation of medical therapy.
  • C-reactive protein level is elevated in patients with extensive pancolitis but is always normal in patients with only distal disease.
  • Cultures of rectal swabs help diagnose gonorrhea or chlamydia.
  • Cultures of vesicular fluid or cytologic scrapings aid in the diagnosis of HSV.
  • Serum Venereal Disease Research Laboratory (VDRL) test and dark field examination of scrapings from the base of the chancre reveals spirochetes and confirms the diagnosis of syphilis.
  • Stool specimen for C difficile toxin.

Procedures

  • Proctosigmoidoscopy reveals the following:
    • Pallor or erythema
    • Loss of usual vascularity of mucosa
    • Prominent telangiectasia
    • Friability
    • Bleeding
    • Ulcerations
    • Edema
    • Scattered areas of scarring
    • Vesicles/pustules
    • Strictures
  • Biopsy for histology, culture, viral studies, and Chlamydia studies
  • Colonoscopy to exclude more proximal involvement

More on Proctitis

Overview: Proctitis
Differential Diagnoses & Workup: Proctitis
Treatment & Medication: Proctitis
Follow-up: Proctitis
References
Further Reading
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References

  1. Babb RR. Radiation proctitis: a review. Am J Gastroenterol. Jul 1996;91(7):1309-11. [Medline].

  2. Bassford T. Treatment of common anorectal disorders. Am Fam Physician. Apr 1992;45(4):1787-94. [Medline].

  3. Bitton A. Medical Management of Ulcerative Proctitis, Proctosigmoiditis, and left-sided colitis. Semin Gastrointest Dis. 2001;12(4):263-274. [Medline].

  4. Denton AS, Andreyev HJ, Forbes A, Maher EJ. Systematic review for non-surgical interventions for the management of late radiation proctitis. Br J Cancer. Jul 15 2002;87(2):134-43. [Medline].

  5. Rafal RB, Nichols JN, Cennerazzo WJ, et al. MRI for evaluation of perianal inflammation. Abdom Imaging. May-Jun 1995;20(3):248-52. [Medline].

  6. Regueiro MD. Diagnosis and treatment of ulcerative proctitis. J Clin Gastroenterol. Oct 2004;38(9):733-40. [Medline].

  7. Spencer CM, McTavish D. Budesonide. A review of its pharmacological properties and therapeutic efficacy in inflammatory bowel disease. Drugs. Nov 1995;50(5):854-72. [Medline].

  8. MacDermott RP. Management of ulcerative proctitis, proctosigmoiditis and left sided colitis. Available at www.uptodate.com. Accessed March 31, 2009.

  9. Nostrant TT. Diagnosis and treatment of chronic radiation proctitis. Up to Date. Available at www.uptodate.com. Accessed March 31, 2009.

  10. Kornbluth A, Sachar DB. Ulcerative colitis practice guidelines in adults (update): American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol. Jul 2004;99(7):1371-85. [Medline].

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Further Reading

Clinical guidelines

Proctitis, proctocolitis, and enteritis. Sexually transmitted diseases treatment guidelines 2006. Centers for Disease Control and Prevention, Workowski KA, Berman SM. Proctitis, proctocolitis, and enteritis. Sexually transmitted diseases treatment guidelines 2006. MMWR Morb Mortal Wkly Rep 2006 Aug 4;55(RR-11):78.

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Keywords

inflammation of the rectum, rectal mucosa, proctosigmoiditis, rectal tissue ischemia, rectal pain, rectal bleeding, proctitis, mucosal cell loss, acute inflammation of the lamina propria, eosinophilic crypt abscess, endothelial edema of the arterioles, mucosal friability, ulcers, strictures, fistula formation, colitis, Crohn disease, Crohn's disease, ulcerative colitis

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Contributor Information and Disclosures

Author

Lisandro Irizarry, MD, MPH, FAAEM, Chair, Department of Emergency Medicine, Brooklyn Hospital Center; Assistant Professor, Department of Emergency Medicine, Weill Cornell School of Medicine
Lisandro Irizarry, MD, MPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Ibis Yarde, MD, Staff Physician, Department of Emergency Medicine, Brooklyn Hospital Center
Disclosure: Nothing to disclose.

Medical Editor

Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine; Program Director, Emergency Medicine Residency, Summa Health System
Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eugene Hardin, MD, FAAEM, FACEP, Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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