Diverticular bleeding: An appraisal based on stigmata of recent hemorrhage

Abstract

Diverticulosis of the colon is often diagnosed as the bleeding site in patients who are hospitalized with severe hematochezia and anemia. In the past, indirect evidence, such as the presence of diverticula on barium enema or elective colonoscopy, was used to make a diagnosis and plan therapy. Surgery was considered definitive management. Various investigators are now recommending a change in this approach because of reports of the success of thoroughly cleansing the colon of blood and clots, the safety and efficacy of urgent colonoscopy, the recognition of incidental diverticulosis, and finding of stignata of diverticular hemorrhage. Also, there are reports that the outcomes of definitive diverticular hemorrhage are significantly improved by endoscopic treatment, compared with medical-surgical therapy, for active bleeding or nonbleeding visible vessels or adherent clots. Furthermore, long-term medical therapy of patients with definitive diverticular hemorrhage (after endoscopic hemostasis) and presumed diverticular hemorrhage appears to prevent most recurrences of colonic diverticular hemorrhage. In other words, surgery to prevent an inevitable recurrence of diverticulosis is not required. A standardized approach to patients with severe hematochezia and colonic diverticulosis is discussed and recommended.