Management and Mismanagement of Bleeding Colonic Diverticula

Ramanath, Hassan K.; Hinshaw, J. Raymond

doi:10.1001/archsurg.1971.01350080227036

Cited by 27 publications

(6 citation statements)

References 6 publications

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“…In our own series of 357 patients operated on for complicated diverticular disease, 40 (11.2%) patients reported rectal bleeding, and 24 of those 40 (60%) patients presented with anemia on admission (hemoglobin concentration below the normal range). Most often there is no inflammation around the diverticulum bleeding [22,35,36,37]. Segmental colitis is rarely associated with diverticula [38,39,40] and hypertension is a predisposing factor [8,10,37].…”

Section: Etiologymentioning

confidence: 99%

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Diverticular disease-associated hemorrhage in the elderly

Buttenschoen

Odermath

et al. 2001

Langenbeck's Archives of Surgery

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Lower gastrointestinal bleeding is frequent in the elderly secondary to diverticular disease and occurs in about 10-30%. It is the most frequent cause of lower gastrointestinal hemorrhage (about 40% of cases) followed by angiodysplasia (up to 20% of cases). The incidence of both diseases increase with age, but the patient's general condition and state of health decrease. Often cardiovascular morbidity coexists, resulting in an eventual risk of ischemic consequences. The intensity of bleeding varies from massive to occult. In diverticular disease, hemorrhage is caused by rupture or erosion of the vasa recti stretched by diverticula. Classically inflammation is absent. Although most diverticula (> 90%) are located in the sigmoid colon, bleeding originates more frequently from the right (> 50%) than the left colon. The preferred diagnostic tool following resuscitation is colonoscopy with an ability to locate the site of bleeding in up to 90% of cases. Additionally, injections and thermocoagulation are available to control bleeding endoscopically with a success rate of about 27%. Angiography is considerably variable concerning positive results (13.6-86%), has a complication rate of about 10% and is expensive. Hence, it is a second-line diagnostic method. Diverticular hemorrhage will cease spontaneously in about 90% of cases. Therefore, conservative treatment is preferred. Patients with persistent, massive or recurrent bleeding despite active conservative measures require surgical treatment. If surgical intervention is necessary, the site of hemorrhage must be sought to allow segmental resection. However, if the source of blood loss cannot be located, a subtotal colectomy is justified.

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Section: Etiologymentioning

confidence: 99%

“…Hypotension following bleeding was considered to support thrombosis of the ruptured vessels [37]. The location of bleeding cannot be assigned by the color of the blood lost [36,61]. Further episodes of hemorrhage occur in up to 25% of cases [26,62,63,64].…”

Section: Clinical Presentationmentioning

confidence: 99%

Diverticular disease-associated hemorrhage in the elderly

Buttenschoen

Odermath

et al. 2001

Langenbeck's Archives of Surgery

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“…Bleeding tends to be a late side effect of diverticular disease and, thus, is seen in an even older age group than diverticular disease as a whole. The average age of presentation for diverticular bleeding ranges from 67.7 to 74.2 years 85–88 . Since diverticulosis is so commonly asymptomatic, as many as 16% of patients’ initial manifestation of disease is gross diverticular bleeding 87 .…”

Section: Complicationsmentioning

confidence: 99%

“…The average age of presentation for diverticular bleeding ranges from 67.7 to 74.2 years 85–88 . Since diverticulosis is so commonly asymptomatic, as many as 16% of patients’ initial manifestation of disease is gross diverticular bleeding 87 . The incidence of bleeding is somewhat more common among women, with a male:female ratio of 4:5 86–88 …”

Section: Complicationsmentioning

confidence: 99%

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Diverticular Disease in the Elderly

Deckmann

1993

J American Geriatrics Society

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Emergency surgery for acute colonic haemorrhage—A retrospective study

Eaton

1981

Journal of British Surgery

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This paper reports a retrospective study of 28 patients undergoing emergency laparotomy and colonic resection for acute colonic haemorrhage out of a total of 292 patients admitted with the condition. The paper concludes that in those cases where the bleeding site cannot be accurately localized angiographically prior to laparotomy, the preferred surgical procedure should be total abdominal colectomy with ileoproctostomy as more limited colonic resection leads to an unacceptably high morbidity and mortality.

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Management and Mismanagement of Bleeding Colonic Diverticula

Cited by 27 publications

References 6 publications

Diverticular disease-associated hemorrhage in the elderly

Diverticular disease-associated hemorrhage in the elderly

Diverticular Disease in the Elderly

Emergency surgery for acute colonic haemorrhage—A retrospective study

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