الفهرس 
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Abstract
The colon is the primary target of many functional and pathological disorders, which may have an acute or chronic presentation.
Over the past few years there has been considerable improvementin the diagnosis of patients with colonic troubles due to the improvementof the diagnostic tools of colorectal diseases.
There are many methods in diagnosing colorectal diseases as: occult blood testing in stool, Barium enema, colonoscopy and recently CT virtual colonoscopy which has several advantages of over conventional colonoscopy as: no sedation, minimally invasive procedure, visualization of the colon next to an obstructing lesion and ease of inspection of both antegrade and retrograde sides of haustral folds.
The aim of the present work is to study the role of CT colonography in comparison with the conventional colonoscopy in the assessment of bleeding per rectum
The study group consists of 34 patients; 22 males, 12 females their The ranged from 22 to 70 years and the mean of age was 47.79 and SD was +_ 12.9 ,referred for standard colonoscopy between January 2011 and December 2013 for evaluation of bleeding per rectum at Gasteroenterology and Endoscopy unit in Agouza Police Hospital with inclusion criteria of :
1. Bleeding per rectum.
2. Anemia associated with colorectal symptoms.
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3. Fifty years old patients or older with previous history of having adenomatous polyps, cancers, family history of colorectal cancers or recent lower GIT symptoms not responding to treatment.
In the present study the colon was divided into six segments: cecum, ascendingcolon, transverse colon “including hepatic & splenic flexures”, descendingcolon, pelvic colon “sigmoid colon &rectosigmoid junction” and rectum.
There were no post-procedural complications after either CT colonography or standard colonoscopy.
Thirty four cases show different colorectal lesions as shown by either colonoscopy or virtual colonoscopy or both.
Ten cases have masses; 5 masses are found in the pelvic colon (sigmoid and rectosigmoid), 2 in the rectum, 2 in the transverse colon including the hepatic and splenic flexure and one in the ascending colon. In six cases the masses are adenocarcinoma and in four cases are tubulovillous adenomas. All masses were detected by both procedures except one mass detected by colonoscopy only. Furthermore, CT virtual colonoscopy was able to detect absence of any other lesions in the proximal colonic segments in four cases the colonoscope could not pass beyond the detected mass lesion and detect liver metastases in a case of adenocarcinoma of the sigmoid colon, lymph node metastases in another case in addition to infiltration of the surrounding mesenteric fat or peri-colic fat was detected in other cases.
five cases have polyps; two polyps are found in the sigmoid colon, one in the rectum, one in the descending colon, one in the
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transverse colon. In case polyps are detected all over the colon (Familial adenomatous polyposis). In three cases the polyps are hyperplastic and their size ≤ 1 cm and in two polyps are tubular adenoma and tubulovillous adenoma and their size > 1 cm. In one case polyp is detected by virtual colonoscopy and not detected by conventional colonoscopy (False positive result) and in other case small polyp 0.5 cm not detected by virtual colonoscopy.
Five cases have IBD (ulcerative colitis) not detected by virtual colonoscopy.
Two cases have angiodysplasia of the colon not detected by virtual colonoscopy.
Two cases have diverticular disease of the colon detected by both procedures.
Ten cases have internal piles only not detected by virtual colonoscopy.
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Conclusion
1. Sensitivity of CT Virtual Colonoscopy in polyp detection increases remarkably hand in hand with the advancement of polyp size and it’s sensitivity for detection of small “ <5mm” polyps is low while conventional Colonoscopy is highly sensitive .
2. CT Virtual Colonoscopy has high sensitivity in the detection of both neoplastic strictures & mass lesions as the Colonoscopy.
3. CT colonography is more reliable and accurate than colonoscopy for polyp measurement.
4. Virtual colonoscopy has the advantage of assessment of the colon proximal to occlusive stenotic lesions which are impassable by conventional colonoscopy.
5. CT Virtual Colonoscopy can detect extra colonic findings as metastases. (Liver and lymph nodes) but cannot detected in Colonoscopy .
6. Virtual colonoscopy has no role in diagnosing mucosal or vascular lesions as inflammation or angiodysplasias. While can be detected by colonoscopy with high accuracy.
7. Virtual colonoscopy can detect colonic diverticulae as Colonoscopy with good accuracy.
8. The majority of evidence suggests that CTC is an acceptable alternative to Colonoscopy, particularly in the group of patients who are either unwilling or unable to undergo Colonoscopy.