MASSIVE DIVERTICULAR BLEEDING: WHEN ENDOSCOPIC TREATMENT IS AN EFFECTIVE OPTION

Diverticular hemorrhage is one of the most common identifiable causes of lower gastrointestinal (GI) bleeding. Although bleeding episodes often are self-limited, massive hemorrhage requiring therapeutic intervention occurs in a significant number of patients. Surgery traditionally has been the treatment of choice in such cases; however studies have suggested that endoscopic diagnosis and therapy using endoscopic procedures could be an initial treatment modality.

We present a case of an 84 year-old woman patient with atrial fibrillation, anticoagulated with warfarin who is admitted to the emergency department due to hematochezia. While in the hospital, she developed massive hematochezia and hypotension, requiring aggressive resuscitation and correction of coagulation. At colonoscopy, multiple scattered diverticula were seen, one of which was noted to have active bleeding.

Epinephrine (2 mL of a 1:10,000 solution) was injected via a standard sclerotherapy needle, and two endoclips (QuickClip 2 Long, Olympus America Corp., Melville, N.Y.) were placed at the bleeding site. Endoclips were applied such that one prong was over the bleeding point within the diverticulum, and the other prong extended over the diverticular lip on to adjacent colonic mucosa. Immediate cessation of hemorrhage was evidenced. On the follow-up, there has been no recurrence of bleeding.