The Therapeutic Barium Enema Revisited

Abstract

The diagnosis and etiology of lower gastrointestinal bleeding from diverticulosis has been well-documented [1,2]. However, the clinical management of lower gastrointestinal bleeding remains a therapeutic dilemma for the physician. Although most bleeding episodes are mild and abate spontaneously with conservative therapy, there remains a subset of patients who present with persistent, massive lower gastrointestinal bleeding. It is the therapy of this subset that remains unde®ned. Although the mainstays in the treatment algorithm for lower gastrointestinal bleeding include the isotope bleeding test, angiography, colonoscopy, and eventual surgical resection for persistent bleeding, these procedures have associated morbidity and mortality [3]. Additionally, those patients whose bleeding persists despite conservative therapy are typically elderly, have associated atherosclerosis, and as a group are not optimal surgical candidates. For example, in a series of 49 patients who underwent total abdominal colectomy for persistent bleeding from diverticulosis, an operative mortality of 27% was reported [4]. In view of the signi®cant risk associated with these invasive procedures, there have been anecdotal reports of the use of the barium enema as a treatment for diverticular bleeding. We present a case where barium enema successfully stopped an episode of bleeding from diverticulosis, and review the literature.