Proctitis in Emergency Medicine Workup

  • Author: Lisandro Irizarry, MD, MPH, FAAEM; Chief Editor: Robert E O'Connor, MD, MPH   more...
 
Updated: Mar 30, 2012
 

Laboratory Studies

  • A complete blood count (CBC) is performed to evaluate for leukocytosis, if an infectious etiology, or severity of anemia due to 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.
Next

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
  • Barium studies are helpful in patients who have obstructive symptoms and are preferred in those patients suspected of having fistulas.
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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.

Specialty Editor Board

Michael S Beeson, MD, MBA, FACEP  Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Akron General Medical Center

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

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.

References

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  2. Hille A, Schmidt-Giese E, Hermann RM, Herrmann MK, Rave-Frank M, Schirmer M, et al. A prospective study of faecal calprotectin and lactoferrin in the monitoring of acute radiation proctitis in prostate cancer treatment. Scand J Gastroenterol. Jan 2008;43(1):52-8. [Medline].

  3. Karamanolis G, Triantafyllou K, Tsiamoulos Z, Polymeros D, Kalli T, Misailidis N, et al. Argon plasma coagulation has a long-lasting therapeutic effect in patients with chronic radiation proctitis. Endoscopy. Jun 2009;41(6):529-31. [Medline].

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

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

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