Arteriographic Diagnosis and Management of Suspected Colonic Diverticular Hemorrhage

Abstract

Abstract Selective arteriography was performed in 12 patients with rectal hemorrhage who were suspected of having diverticulosis as the cause of bleeding. Four patients had negative arteriography and have had no recurrence of hemorrhage. In 4 patients, the hemorrhage was due to a lesion other than diverticulosis. These included 1 patient each with malignant lymphoma, intestinal ischemia, cecal ulcer, and arteriovenous malformation of the small bowel. Four patients were bleeding from diverticular disease of the colon, including 3 patients with diverticulosis and 1 patient with diverticulitis. Three of these patients were treated with intraarterial infusion of vasopressin. In each case bleeding stopped for at least 24 hr resulting in significant improvement in the preoperative condition of these patients. Selective arteriography in patients in whom hemorrhage is thought to be due to colonic diverticular disease is indicated to (1) exclude other causes of rectal hemorrhage, (2) accurately localize the site of the bleeding diverticulum, (3) allow a trial of nonoperative control of hemorrhage by infusion of vasopressin or other vasoconstrictor agents, and (4) allow more specific and limited colonic resection when bleeding is uncontrolled or recurrent.