Cause Of Lower Gastrointestinal Bleeding Research Articles

Causes and Management of Lower Gastro-Intestinal Bleeding

Gastrointestinal (GI) bleeding from the colon is a communal reason for hospitalization and is being more frequent in older patients. Gastrointestinal bleeding is known as any bleeding that takes place in the GIT from mouth to anus. Lower GI bleeding is defined as bleeding distal to the ligament of Treitz. Lower GI bleed is typically presented as hematochezia which is the passing of bright red blood clots or burgundy stools through the rectum. The causes of lower GI bleeding are changing over the past several decades from diverticulosis (which is the protrusion of the colon wall at the site of penetrating vessels), infectious colitis, ischemic colitis, angiodysplasia, inflammatory bowel disease, colon cancer, hemorrhoids, anal fissures, rectal varices, dieulafoy lesion, radiation-induced damage following cancer treatment to post-surgical. Management of lower GI bleeding is done through assessing the severity of symptoms and the condition of the overall case.

Clinical Profile and Colonoscopic Findings in Patients Presented with Lower Gastrointestinal Bleeding in UCMS

INTRODUCTION
 The lower gastrointestinal bleeding (LGIB) is an alarming symptom and common disease with annual admission of 0.15% with mortality rate of 5-10%. LGIB is caused by neoplastic and non-neoplastic lesions. For accurate diagnosis of various colorectal lesions, colonoscopy is gold standard, convenient and cost effective procedure. It is the investigation of choice in LGIB and helps in early diagnosis of colorectal carcinoma. This study was aimed to scrutinize the clinical and colonoscopic findings in patients with LGIB in UCMS.
 
 MATERIAL AND METHODS
 This was a hospital based prospective observational study conducted after taking permission from institutional review committee in January 2017 at UCMS-TH from 15th January 2017 to 15th January 2018. All patients presenting with LGIB who fulfilled inclusion and exclusion criteria and gave written consent were included.
 
 RESULTS
 Total 88 patients were included in the study. The mean age of our patients was 48 ±17 years with age range from 17-81 years. Majority were in the age group 50-60 years (25%) (n=22). Colonoscopy detected abnormality in 73.8% cases. The common non-neoplastic were haemorrhoids and non-specific colitis (14.5% each) followed by 12.5% of neoplastic cases. The higher frequency of colorectal lesions was observed in males comprising 72.7% (n=64) patients. The most commonly diagnosed etiologies of LGIB were haemorrhoid and nonspecific colitis respectively.
 
 CONCLUSION
 Colonoscopy detected abnormality in 75% of cases. The common causes of LGIB were haemorrhoids and non-specific colitis followed by neoplastic lesion. A careful history, physical and colonoscopic examination with or without biopsy makes significant impact for early diagnosis and treatment.

Nontraumatic tube method for detecting a vessel responsible for colonic diverticular hemorrhage.

Colonic diverticular hemorrhage has been reported as the most common cause of lower gastrointestinal bleeding [1] [2] [3]. In colorectal diverticular hemorrhage, active bleeding, nonbleeding visible vessels, and adherent clot (indicating active bleeding or nonbleeding visible vessels when removed) are defined as stigmata of recent hemorrhage (SRH) [4].

A rare cause of lower gastrointestinal bleeding treated with robotic colorectal surgery

BackgroundMetastatic melanoma to the colon is rarely diagnosed with an incidence of only 0.3% and more than 95% of cases identified post-mortem. Survival for patients with metastatic melanoma to the colon is poor, with 5-year survival rates of 26.5%. Nonetheless, surgical resection of the colonic metastatic melanoma lesions is recommended as it is associated with improved survival. Additionally, surgical resection is also indicated for palliative reasons, as symptom resolution is achieved in 90% of such patients. Use of the surgical robot has increased dramatically in the past decades, especially in the field of colorectal surgery. Furthermore, recent studies have demonstrated comparable outcomes between patients undergoing either laparoscopic or robotic-assisted colorectal surgery for cancer. Here, we describe the first case, to the authors knowledge, of a robot-assisted sigmoid colectomy for metastatic melanoma.Case presentationA 72-year-old male with a history of metastatic melanoma diagnosed in 2015 with a favorable response to immunotherapy presented to the emergency department with symptomatic lower gastrointestinal bleeding (LGIB). Endoscopy demonstrated a friable melanotic lesion of the sigmoid colon with biopsy demonstrating histopathologic evidence of metastatic melanoma. After further evaluation, the patient consented for an elective robot-assisted segmental colectomy for palliative intent. Diagnostic laparoscopy identified no evidence of further intra-abdominal metastatic disease. After identifying the metastatic lesion in the sigmoid colon, the mesentery of involved segment of sigmoid colon adjacent to the lesion was divided using the bipolar electrosurgical vessel sealer device. The colon was divided both proximal and distal to the lesion using a robotic stapler and a tension-free colo-colonic anastomosis was created intracorporeally. Postoperatively, the patient had an unremarkable course and was discharged home on post-operative day 3. On follow-up, the patient was doing well with resolution of preoperative LGIB.Conclusion This case highlights a rare presentation of metastatic melanoma to the colon in a patient presenting with LGIB. Furthermore, this case demonstrates the feasibility of the minimally invasive robotic-assisted approach for an uncommon pathology.

Etiologies and outcome of lower gastrointestinal bleeding in patients presenting to a tertiary care Children's Hospital.

Objective:To determine etiology and outcome of children with lower gastrointestinal bleeding (LGIB).Methods:This was a prospective study conducted at the Department of Pediatric Gastroenterology and Hepatology, Children’s Hospital and The Institute of Child’s Heath, Multan, Pakistan, from July 2019 to March 2020. A total of 148 cases presented with bleeding per rectum and underwent colonoscopy, were included. Children of both genders and aged three month to 15 years were included. Detailed history, clinical examination, laboratory studies, colonoscopy and histopathology were done in all cases. Study information like demographics, complaints, general clinical examination, colonoscopy and histopathological findings were recorded.Results:Overall, mean age was noted to be 7.20±1.83 years. Abdominal pain was reported in 41 (27.7%), diarrhea 36 (24.3%), fever 12 (8.1%) and constipation in 4 (2.7%). Pallor was noted among 68 (45.9%), weight loss 39 (26.3%) and tachycardia 31 (20.9%). Colonoscopy revealed juvenile colonic / rectal polyps, infectious colitis and solitary rectal ulcer (SRU) as the most common etiologies found among 58 (39.2%), 20 (13.5%) and 19 (12.8%) cases respectively. Juvenile polyps and non-specific colitis were the commonest histopathological findings seen in 55 (37.2%) and 20 (13.5%) cases respectively. Colonoscopic polypectomy was used to remove all juvenile polyps.Conclusion:LGIB is presentation of various underlying causes. Children with LGIB commonly present with abdominal pain. Juvenile polyps were the most frequent cause of LGIB among children flowed by non-specific colitis. Most of the children having LGIB were diagnosed and treated successfully, few are in remission and very few were found resistant to treatment.

An unusual cause of lower gastrointestinal bleeding

AbstractAcute lower gastrointestinal (GI) bleeding refer to blood loss of colon origination. The cause of lower GI bleeding may include vascular (ulcer, angiodysplasia, ischemic, or radiation), anatomic (diverticulum), inflammatory (ulcerative colitis, Crohn's disease), infectious, or neoplastic. Mesenteric venous thrombosis is responsible for 5% to 15% of all mesenteric ischemic events, and the involvement of the inferior mesenteric vein (IMV) is rare. A 70‐year‐old man who presented with episodes of bloody diarrhea. Colonoscopy revealed diffuse hyperemic changes in the rectum and sigmoid colon. A contrast‐enhanced computed tomography showed diffuse, circumferential wall thickening of the descending colon, sigmoid colon, and rectum as a result of thrombosis in the IMV. Anticoagulant was administered and there was no further bloody diarrhea. Mesenteric venous thrombosis is a rare cause of lower GI bleeding. However, it may be kept in mind in high risk populations such as malignancy, prothrombotic states, inflammatory bowel disease, recent abdomen injury or surgery, and diabetes mellitus.

Risk score for assessment of adults with acute gastrointestinal haemorrhage: A prospective study

Gastrointestinal (GI) bleeding has created an increasing demand for medical and surgical care; in addition, It is potentially serious and considered life-threatening in all age groups. This prospective study aims to find out the most common causes of GI bleedings, the incidence, the mode of treatment, and to investigate whether a simplified clinical score was able to predict the level of severity in the emergency department. About 170 patients aged (19 – 73) years who had been admitted to the emergency department in Baghdad teaching hospital were prospectively evaluated according to the causes of GI bleeding they presented with, the mode of treatment, and the degree of severity. Out of 170 patients included in this study, 95 patients (55.88%) were males, and 75 patients (44.12%) were females, with an average age of 41.11 years. The causes of GI bleeding were peptic ulcer (29.41%), gastritis (18.82%), diverticulitis (8.82%), hemorrhoids (8.23%), colonic cancer (7.64%), inflammatory bowel diseases (7.64%), anal fissure (7.05%), mesenteric ischemia (7.05%) and oesophagal varices (5.29%). Most of the cases of a peptic ulcer due to duodenal ulcer. Diagnostic endoscopy and conservative management were the main modes of treatment in these patients. Peptic ulcer and gastritis appear to be the main causes of GI bleeding, especially upper GI bleeding, while diverticulitis seems to be the main cause of lower GI bleeding and can be managed conservatively. Haemorrhoids and anal fissures will be managed surgically, either elective or emergency surgery. Also, our simplified clinical score appeared to be associated with the detection of the level of severity, which may deserve urgent interventions.

Right-sided diverticulosis is an independent risk factor for bleeding in patients admitted for diverticular disease

BackgroundDiverticular bleeding is the main cause of lower gastrointestinal bleeding in both Eastern and Western countries. Several risk factors have been identified, such as comorbidities and concomitant medications. In Eastern population, the prevalence of right-side diverticulosis is higher than in Western one, and some Authors identified bilateral diverticulosis as a risk factor for bleeding. AimsTo identify risk factors for diverticular bleeding in patients admitted for diverticular disease (DD). MethodsAll patients admitted for DD from January 2017 to December 2018 were retrieved from the hospital Information System. For each patient, age, gender, clinical presentation and concomitant medication were recorded. All patient underwent imaging assessment (computed tomography, ultrasound or MRI) and colonoscopy during hospitalization or within one month. ResultsAmong 1248 patients discharged with a diagnosis of DD during the study period, 293 (52.2% male, median age 75 years) were finally analyzed; of them, 105 (35.8%) for diverticular bleeding. On multivariate analysis, male gender (OR 4.27), age (OR 1.12), anti-thrombotic medications (OR 2.60) and right-sided DD (OR 5.70) were independently correlated to diverticular bleeding. ConclusionOur study provides evidence that, together with age, male gender and concomitant anti-thrombotic treatment, right-sided DD represents an independent risk factor for bleeding.

Dieulafoy lesion in the colon: a rare cause of lower gastrointestinal bleeding.

Dieulafoy lesion in the colon: a rare cause of lower gastrointestinal bleeding.

Effect of tranexamic acid in patients with colonic diverticular bleeding: A nationwide inpatient database study.

The effect of tranexamic acid (TXA) remains unknown in patients with colonic diverticular bleeding, which is one of the most common causes of lower gastrointestinal bleeding. We investigated the efficacy of TXA for patients with colonic diverticular bleeding. We performed a nationwide observational study using the Japanese Diagnosis Procedure Combination database and identified patients who were admitted for diverticular bleeding from 2010 to 2018. Patients who received TXA on the day of admission comprised the TXA group, and the remaining patients comprised the control group. The primary outcome was in-hospital mortality. Secondary outcomes included severe bleeding, blood transfusion within 7days of admission, length of stay, and hospitalization costs. Propensity score matching was performed to compare outcomes between the two groups. Overall, 78291 patients met our eligibility criteria, and 30526 matched pairs were created by one-to-one propensity score matching. After matching, there was no significant difference in in-hospital mortality between the two groups (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.88-1.30); however, TXA administration was associated with significantly lower proportions of severe bleeding events (OR, 0.93; 95% CI, 0.89-0.99), blood transfusions (OR, 0.88; 95% CI, 0.84-0.92), shorter length of stay (difference, -0.23days; 95% CI, -0.01 to -0.44days), and lower total hospitalization costs (difference, -$233; 95% CI, -$153 to -$314). Although TXA was not significantly associated with lower in-hospital mortality, it may reduce severe bleeding, blood transfusions, length of stay, and hospitalization costs.

Super-Selective Mesenteric Embolization as Guide for Surgical Resection in Bleeding Small Bowel Angiodysplasia

We present the case of a 79-year-old woman and of a 43-year-old man with no relevant past medical history. Both patients were admitted to the emergency department for anemia and rectal bleeding. After resuscitation, the two patients underwent colonoscopy and gastroscopy, both negative. Computed tomography angiography revealed active bleeding from the small bowel in both cases. The first patient underwent angiography and mesenteric embolization with surgical glue, obtaining a complete stop of the bleeding. After 2 days, a small bowel resection was performed under the guidance of the segmental bowel ischemia secondary to embolization. In the second patient, the angiography revealed a large jejunal angiodysplasia. Therefore, a mesenteric super-selective embolization was carried out. The intraoperative identification of the coils allowed to guide the following bowel resection. The postoperative course was uneventful in both patients. Small bowel angiodysplasia is a rare cause of lower gastrointestinal bleeding. In most patients, bleeding stops spontaneously. However, patients with ongoing active bleeding non-responding to conservative treatment may need invasive procedures. The use of super-selective mesenteric embolization is highly successful and relatively safe. When surgery is necessary, identification of the bleeding site is troublesome. In this setting, angioembolization could help to identify the correct site of bleeding, thus allowing to perform a segmental small bowel resection.

Delayed Massive Lower Gastrointestinal Bleeding Secondary to Suprapubic Cystostomy, A Case Report of Very Rare Complication

Introduction: Suprapubic cystostomy is a common procedure in urology. Bowel perforation is the most serious and rare complication. This report highlights the first published case of massive lower gastrointestinal bleeding as a complication secondary to suprapubic cystostomy. Case presentation: A sixty-seven-year-old patient with benign prostate hyperplasia had a suprapubic catheter inserted under spinal anesthesia, during concurrent cystoscopy. It was functioning well after insertion. Twelve days later, he developed massive hematochezia. On examination, he was hemodynamically stable. There was a demonstrable right lower abdominal tenderness and the digital rectal examination revealed dark red blood. The suprapubic cystostomy was draining clear urine without leakage. Investigations revealed a hemoglobin 6 g/dL and normal INR. Two units of packed red blood cells were given. A colonoscopy showed a normal colon with blood coming from above the ileocecal valve area. Upper endoscopy was normal. A red blood cell scan revealed active bleeding at the terminal ileum. A computerized tomography scan of the abdomen with IV contrast showed that the suprapubic catheter had passed into terminal ileum causing active bleeding. Exploratory laparotomy confirmed the presence of suprapubic catheter passing to the terminal ileum. The suprapubic catheter was removed, the unhealthy bowel resected, and anastomosis performed with no immediate post-operative complications. Conclusion: This case determines the importance of keeping careful watch for possible bowel injury after cystostomy and should be considered a rare complication and cause of lower gastrointestinal bleeding.

Delayed Massive Lower Gastrointestinal Bleeding Secondary to Suprapubic Cystostomy, A Case Report of Very Rare Complication

Introduction: Suprapubic cystostomy is a common procedure in urology. Bowel perforation is the most serious and rare complication. This report highlights the first published case of massive lower gastrointestinal bleeding as a complication secondary to suprapubic cystostomy. Case presentation: A sixty-seven-year-old patient with benign prostate hyperplasia had a suprapubic catheter inserted under spinal anesthesia, during concurrent cystoscopy. It was functioning well after insertion. Twelve days later, he developed massive hematochezia. On examination, he was hemodynamically stable. There was a demonstrable right lower abdominal tenderness and the digital rectal examination revealed dark red blood. The suprapubic cystostomy was draining clear urine without leakage. Investigations revealed a hemoglobin 6 g/dL and normal INR. Two units of packed red blood cells were given. A colonoscopy showed a normal colon with blood coming from above the ileocecal valve area. Upper endoscopy was normal. A red blood cell scan revealed active bleeding at the terminal ileum. A computerized tomography scan of the abdomen with IV contrast showed that the suprapubic catheter had passed into terminal ileum causing active bleeding. Exploratory laparotomy confirmed the presence of suprapubic catheter passing to the terminal ileum. The suprapubic catheter was removed, the unhealthy bowel resected, and anastomosis performed with no immediate post-operative complications. Conclusion: This case determines the importance of keeping careful watch for possible bowel injury after cystostomy and should be considered a rare complication and cause of lower gastrointestinal bleeding.

Indications and findings of lower gastrointestinal endoscopy: a retrospective study in Eastern Regional Hospital, Koforidua, Ghana

INTRODUCTION: Colonoscopy is a safe and effective means of visual inspection of the large bowel from the distal rectum to the caecum. There is a paucity of data on this procedure in Ghana. The only data in literature are from Kumasi and Accra. This paper reviews the indications and findings of lower gastrointestinal endoscopy (LGIE) in Eastern Regional Hospital, Koforidua, Ghana. METHODS: a retrospective study was undertaken on patients who underwent colorectal endoscopy between January 2019 and December 2019. RESULTS: one hundred and six (106) LGIE procedures were performed. Sixteen patients had flexible sigmoidoscopy and the rest had full colonoscopy. Of those who had colonoscopy, caecal intubation rate was 86.2%. Males were 69 and mean age 56.67 ± 16.48. The most common primary indication was bleeding per rectum. The most common primary endoscopic finding was haemorrhoids (54.17%) followed by colorectal tumors (15.0%). 11.6% of the patients had normal endoscopic findings. A diagnosis of haemorrhoids was made in 61.6% of those presented with bleeding per rectum as an indication and was the commonest cause of lower gastrointestinal bleeding (LGIB). CONCLUSIONS: the commonest indication for colonoscopy was rectal bleeding, while the most frequent pathology was haemorrhoids. The proportion of our patient population found to have a colorectal tumor or polyps was not insignificant. Screening program for colorectal cancer in Ghana should be considered.

Tranexamic acid for bleeding in a child with extensive small bowel angiodysplasia

Abstract Gastrointestinal (GI) angiodysplasia is a rare cause of lower GI bleeding in the paediatric population. This disease caused intermittent per-rectal bleeding and severe anemia in 2-year-old girl with Turner's syndrome. She was initially suspected to have Meckel's diverticulum and taken to the operation room for laparoscopy. A Meckel's diverticula was not found but an extensive distribution of abnormal vessels on the surface of the small bowel was noted from close to the duodeno-jejunal junction to the terminal ileum. GI angiodysplasia was suspected but the lesion was too extensive to be resected. It was also not clear if any specific area was the source of the current bleeding. After conversion to open surgery, an enterotomy was done in the mid portion of the affected bowel and an on table enteroscopy was done. This revealed a normal mucosal lining in the visualized areas and so was not contributory. Prior to closure of the enterotomy a doughnut of bowel was taken for histopathology. This confirmed small bowel angiodysplasia. She had one minor recurrence of lower GI bleeding 4 months later but has been well since then. This case sheds light on angiodysplasia as a cause of lower GI bleeding and we discuss its diagnostic and management options.

Lower Gastrointestinal Bleeding in Patients With Cirrhosis—Etiology and Outcomes

Lower gastrointestinal bleeding (LGIB) is a common clinical problem, and may be more prevalent among patients with cirrhosis, especially in the setting of portal hypertension and coagulopathy. However, there is extremely little data available on the subject of LGIB in patients with cirrhosis. Therefore, the primary objective of this study was to better understand the etiology and outcomes of cirrhotic patients hospitalized with LGIB. We analyzed 3,735 cirrhotic patients admitted to the Medical University of South Carolina between January 2011 and September 2018, and identified patients admitted with a primary diagnosis of hematochezia or bright red blood per rectum. Thirty patients with cirrhosis and LGIB were included in the cohort. The mean age was 56 ± 13 years, with 30% women. The mean model of end stage liver disease score was 22, and Child-Pugh (CP) scores were C: 41%, B: 33% and A: 26%. The mean Charlson Comorbidity Index was 5.6. Twenty-four (80%) patients had a clinical decompensating event (hepatic encephalopathy, ascites, esophageal varices); the mean hepatic venous pressure gradient was 14.1 mm Hg (n=8). In 33% of patients, LGIB was considered significant bleeding that necessitated blood transfusion. The most common cause of LGIB was hemorrhoids (11 patients, 37%), followed by portal hypertensive enteropathy or colopathy (7 patients, 23%). Hemoglobin levels on admission were lower in patients with CP B/C cirrhosis than in those with CP A (P < 0.001). The length of stay was 9 ± 10 days, and 5 patients died (mortality, 17%). Despite being uncommon, LGIB in cirrhotic patients is associated with a high mortality rate.

Colonoscopy findings in lower gastrointestinal bleeding in Lagos: A comparative study based on age.

Lower gastrointestinal bleeding (LGIB) (hematochezia) is an important indication for colonoscopy, and may be caused by hemorrhoids, diverticulosis, and tumors. The aim of this study was to compare the endoscopic findings in the young (<50 years) versus older subjects (≥50 years) with LGIB in Nigeria. This was a retrospective study of the endoscopic findings of all adults with LGIB from January 2017 to December 2019 in Lagos, Nigeria. The records of two centers that deliver outpatient gastrointestinal endoscopic services were ploughed for biodata, presenting complaints and findings in these individuals. These data were then analyzed and are thus presented. A total of 1,774 colonoscopies performed during this period, 793 were for LGIB. Of those with LGIB, 548 (69.1%) were males, 245 (30.9%) were female, mean age was 50.7 (±14) years, and 403 (50.8%) were younger than 50 years old. The most frequent findings in patients younger than 50 years were hemorrhoids (316, 78.4%), tumors (35, 8.7%), and polyps (27, 6.7%), while in the older patients, they were hemorrhoids (259, 66.4%), tumors (74, 19%) and diverticulosis (55, 14.1%). Younger age was significantly associated with the presence of hemorrhoids (P < 0.005), while older age was significantly associated with the presence of tumors (P < 0.005) and diverticulosis (P < 0.005). Our study showed that hemorrhoids, tumors, and diverticulosis were the most common causes of LGIB in Nigerian patients - with younger age being significantly associated with hemorrhoids, and older age with tumors and diverticulosis. A third of the tumors in this study were found in younger patients. Unfortunately, this finding of such a high proportion of colorectal tumors being found in young Africans has been shown in previous reports - this work should help heighten concern and provoke further scientific probing into the phenomenon with a view to encouraging policy to help truncate its existence.

Colonoscopic Finding of Patients with Lower Gastrointestinal Bleeding at Different Age Group in Eastern Part of India - An Observational Study.

Incidence of lower gastrointestinal (GI) bleeding (LGIB) is increasing over time. It can be seen in all age group patients, commonly associated with pre-existing comorbidities and is one of the common indications of colonoscopy. This study was done to identify common causes of LGIB in eastern part of India, because there is no previous study from Eastern India to identify the common causes of lower GI bleeding diagnosed by colonoscopy in different age group patients. Consecutive 64 patients with LGIB were included in this study from June 2018 to March 2019. We divided our study population into three groups, such as group A (20 years to 40 years), group B (41 years to 60 years), and group C (more than 60 years). Data were entered into Excel and then transferred into SPSS version 22 for statistical analysis. Mean age of study population was 49.83 ± 19.06 years. Normal colonoscopic finding was seen in 7 patients (10.9%). Most common colonoscopic findings of our study population were hemorrhoids (n=32; 50%), anal fissure (n=11; 17.2%) and isolated rectal ulcer (n=9; 14.1%). Colorectal growth was seen in 6 patients (9.4%), among them female patients were more commonly affected than male patients. Therefore, most common causes of LGIB in eastern part of India are hemorrhoids, anal fissure and isolated rectal ulcer. Male individuals are more commonly affected by LGIB.

Lower GI Bleeding: An Update on Incidences and Causes.

Bleeding from the lower gastrointestinal tract represents a significant source of morbidity and mortality. The colon represents the vast majority of the location of bleeding with only a much smaller incidence occurring in the small intestine. The major causes of lower gastrointestinal bleeding (LGIB) are from diverticulosis, vascular malformations, and cancer. We discuss the incidence and causes of LGIB.

602 Angiography Versus Colonoscopy in Diverticular Hemorrhage

INTRODUCTION: Diverticular hemorrhage is the most common cause of lower gastrointestinal hemorrhage. Determining the source of bleeding is difficult and therapeutic intervention rates are variable. Many centers perform angiography for patients with more severe bleeding since it does not require bowel preparation and can be rapidly performed; however it has never been directly compared to colonoscopy and may not be available. Using the national inpatient sample, we compared outcomes for patients with diverticular bleeding undergoing angiography to colonoscopy. METHODS: This national inpatient sample (NIS) from 2016 was queried for cases of diverticular hemorrhage based on ICD-10. Outcomes were compared for colonoscopy alone to angiography including mortality and rate of post-procedure transfusion. Angiography use was compared by hospital type to deduce if there was an availability bias in usage pattern. Survey-adjusted logistic regression was used to examine mortality and predictors of angiography use. Adjustment was made for the Elixhauser mortality score (a validated measure of comorbidities) and other confounders as below. RESULTS: 63,620 patients were admitted for diverticular hemorrhage in 2016. 2,795 (4.4%) underwent angiography and 40,380 (63.5%) underwent colonoscopy. 62.3% of angiography patients had a colonoscopy (98.6% prior to the angiogram). Angiography was more common in patients at academic (5.1%) and urban non-teaching (4.0%) compared with rural (0.5%) hospitals. Mortality was 2.3% in patients undergoing angiography versus 0.8% in patients undergoing colonoscopy alone. In the multivariable regression, requiring angiography was associated with a 3.2 times the odds of mortality (95% CI 1.7-6.0) adjusting for age, transfusion requirement and Elixhauser. Adjusting for age, Elixhauser and transfer status, freedom from transfusion (OR = 0.34, 95% CI 0.28-0.40) and rural hospital location (OR = 0.13, 95% CI 0.06-0.28 compared to urban teaching) were strongly associated with angiography. CONCLUSION: In a national cohort of patients managed for diverticular bleeding, angiography was performed in under 5% compared with nearly 64% who had colonoscopy. However, it was associated with a higher rate of mortality though not transfusion. This persisted after controlling for confounders. Far fewer patients underwent angiography at small community hospitals, raising concern about the availability of this resource in the community setting.