Acute Proctitis Workup

Updated: Nov 09, 2018
  • Author: Lisandro Irizarry, MD, MBA, MPH, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Laboratory Studies

Consider the following 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.

  • C-reactive protein level is elevated in patients with extensive pancolitis but is frequently 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.



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

Perform a biopsy for histology, culture, viral studies, and Chlamydia studies.

Perform 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.