Background: Rigid sigmoidoscopy (RS) in the present era of flexible sigmoidoscopies is falling out of favor although it continues to be used in some centers as an outpatient (OP) department procedure. Aims: This study aims to determine the utility of RS for diagnosis of rectosigmoidal pathologies in the OP setting with emphasis on neoplastic lesions. Methods: We retrospectively studied the RS records and histopathology reports (HPRs) of 5 years (July 2013–June 2018) done in the Department of Gastroenterology at Medical College Calicut. Results: During the study period, 9418 RS examinations were done, and a total of 6921 abnormalities were picked up, giving a diagnostic yield of 73.5%. Most common indication was bleeding per rectum (PR) (51%), followed by constipation (29%). The most common lesion found was hemorrhoids 39.8% followed by proctitis 13.7%, neoplasms 9.7%, and others 10.3% while 26.5% studies were normal. HPRs showed 7.7% to be malignant, 5.8% were adenoma, 12.2% were inflammatory bowel disease ulcerative colitis (IBD UC), 2.2% were solitary rectal ulcer syndrome, 1.2% nonspecific colitis, 1.7% nonneoplastic polyps, 2.7% were normal, and 1.4% were inconclusive. Of the 4812 patients with complaints of bleeding PR, 4739 (98.5%) had a diagnosis after RS, of which hemorrhoids (72.7%) was the most common cause followed by proctitis (14.2%), neoplasm (9%), and others (4.1%). The sensitivity, specificity, positive predictive value, and negative predictive value of RS in detecting neoplasia was 98.2%, 96.8%, 66.1%, and 99.9%, respectively, when HPR was gold standard. RS was found to be effective for assessing activity in IBD UC. Conclusion: RS is a simple, cheap, and effective tool for diagnosing various rectosigmoid pathologies. RS can be used as an effective screening test for rectosigmoid pathologies, especially neoplasia and IBD UC.

Intravenous administration of hydrocortrisone 100 mg three times daily was initiated. The subsequent followup of the patient in the outpatient department showed symptomatic improvement and the steroid was tapered to

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BACKGROUND Crohn's disease is a chronic inflammatory disease, which involves almost all parts of body. Perianal manifestations maybe the initial presentation in these patients, but usually includes other systemic manifestations along with it. This study was conducted to determine presence of perianal disease as the initial manifestation in otherwise asymptomatic Crohn's patients. MATERIALS AND METHODS This study was conducted in Department of Gastroenterology in a tertiary care hospital. All patients presenting with perianal manifestations were evaluated with colonoscopy and other imaging (in selected cases) to identify Crohn's disease. RESULTS A total of 46 patients were evaluated for perianal disease, out of which 3 patients (6.5%) had evidence of Crohn's disease in colonoscopy. Major presentation in these patients were skin tags (n=27, 58.6%), anal fissures (n=15, 32.6%) and fistula (n=4, 8.6%). The major symptoms were pain in perianal region (n=38, 82.6%), bleeding PR (n=23, 50%), anal pruritus (n=8, 17.3%) and mucus discharge PR (n=7, 15.2%). CONCLUSION Perianal disease maybe the initial presentation in Crohn's disease. Judicious evaluation of these perianal lesions helps in early diagnosis of Crohn's disease.