Usefulness of Contrast-Enhanced CT on Arrival in Colonic Diverticular Bleeding

Abstract

Contrast-enhanced computed tomography (CT) and colonoscopy are very useful for the diagnosis and treatment of colonic diverticular bleeding. However, the timing of CT has been reported in few cases. The aim of this study was to demonstrate the usefulness of contrast-enhanced CT on arrival in colonic diverticular bleeding. We conducted a review of the data of patients that were diagnosed with colonic diverticular bleeding between July 2010 and December 2021. Eighty-two patients (51 males, 31 females, average age 69.1 years) were admitted with diagnosis of colonic diverticular bleeding after undergoing contrast-enhanced CT. We retrospectively investigated the relationship between the initial diagnosis by contrast-enhanced CT on arrival at the hospital and the results of endoscopic identification. Contrast-enhanced CT showed extravasation of contrast medium in 30 cases. The time from the onset of bloody stool to the implementation of contrast-enhanced CT was significantly shorter in cases with extravasation images in the CT (average 7.9 hours) than in cases without extravasation images in the CT (average 15.3 hours). The identification rate of diverticular bleeding sites with colonoscopy was significantly higher in cases with extravasation images in the CT (83%) than in cases without extravasation images in the CT (36.5%). The final treatment methods were endoscopic hemostasis in 46 cases, medical treatment alone in 26 cases, transcatheter arterial embolization (TAE) in 8 cases, and surgery in 2 cases. For patients suspected of colonic diverticular bleeding, performing contrast-enhanced CT early and estimating the bleeding site before colonoscopy may lead to the success of endoscopic hemostasis. To identify and treat successfully colonic diverticular bleeding by colonoscopy, the early use of contrast-enhanced CT before colonoscopy is highly recommended.