The role of flexible sigmoidoscopy in the evaluation of patients presenting with a lump at anus

Objective In certain units, flexible sigmoidoscopy is routinely done in patients presenting with a lump at anus, even if an obvious cause is seen on proctoscopy. This is to look for primary causes and to detect other additional lesions. However, routine flexible sigmoidoscopy has led to many negative sigmoidoscopies. Materials and methods A retrospective analysis of 556 consecutive patients presenting with lump at anus with or without painless bleeding per rectum over a period of 9 years was carried out. Those with additional symptoms such as alteration of bowel habits and abdominal pain were not included. All the patients underwent a digital rectal examination, proctoscopy and flexible sigmoidoscopy. Results Median age at presentation was 49 years (range16-89) (Male: female = 1.3:1). Of those, 175 (31.47%) were aged 40 years or less. The majority (N = 361, 64.9%) had haemorrhoids only. In the majority (90.83%), apart from lesions identified by clinical examination and proctoscopy no additional lesions could be identified. Of those aged 40 years or less, 1 patient (0.6%) had a benign polyp while in those aged more than 40 years, 5.2% had benign polyps, and 1 (0.3%) patient had carcinoma. Only 2 patients (1.2%) aged less than 40 had additional lesions, which were benign. Conclusion Our study shows that flexible sigmoidoscopy was of some value mainly in those over the age of 40 years. Those who are aged 40 years or less and who are diagnosed to have a lesion on clinical examination and proctoscopy may be treated for the same without further endoscopy.