Q&A: Do I Need Another Colonoscopy?
I'm a 68 year old woman with a history of heart disease. Last week, I was hospitalized with abdominal pain, diarrhea and rectal bleeding. I was placed on antibiotics and the emergency doctor ordered a CT scan which was read as having colitis. I was discharged and I am feeling better. I last had a colonoscopy five years ago. My symptoms have improved with the antibiotics. I have an appointment with my gastroenterologist in a few weeks. Will he want to do another colonoscopy?
The possibilities or differential diagnosis of your symptoms is vast. First off, is an infectious colitis. The most common bacteria to cause this are Salmonella, Shigella and Yersinia. Another possibility is ischemic colitis. This is common in elderly patients, especially with underlying heart disease. It is caused by a transient lack of blow flow to the intestines. Inflammatory bowel disease, both Crohn's disease and ulcerative colitis can present in patients in their 60's as well.
Antibiotics can lead to improvement in colitis regardless of the type, whether it is it related to infectious colitis or inflammatory bowel disease. Ischemic colitis typically will resolve on its own over time. Acute colitis on a CT scan is generally a contraindication to colonoscopy. The air insufflated in the colon during the procedure can lead to a thinning out of the inflamed colon, resulting in perforation. While a gentle examination can be performed to help in making a diagnosis if there is no improvement, it is generally best to wait about four weeks if possible. Since you are improving, that is a good sign. Your gastroenterologist will likely want to perform a colonoscopy in a month or so to see if there is any persistent colitis, as well as to rule out colon cancer, although from your story that would be very unlikely.