Colonic Diverticulosis and Diverticular Hemorrhage

Colonic diverticulosis predisposes individuals to lower gastrointestinal hemorrhage in up to 5% of cases. These sac-like protrusions are pseudodiverticula and arise due to a combination of anatomic, dietary, motility, and structural influences. In the setting of acute hemorrhage, patient stabilization takes priority, followed closely by maneuvers aimed at localizing and controlling blood loss. Through the use of an arsenal of tools including colonoscopy, angiography, and nuclear scintigraphy, most diverticular bleeds can be localized and subsequently controlled. When persistent and not controlled by colonoscopic or angiographic means, expeditious surgical resection serves as definitive therapy.

KEYWORDS

Diverticulosis - gastrointestinal hemorrhage - diverticulitis

REFERENCES

• 1 Parks T G. Natural history of diverticular disease of the colon.  Clin Gastroenterol. 1975;  4 53-69
• 2 Painter N S, Burkitt D P. Diverticular disease of the colon, a 20th century problem.  Clin Gastroenterol. 1975;  4 3-21
• 3 Painter N S, Burkitt D P. Diverticular disease of the colon: a deficiency disease of Western civilization.  Br Med J. 1971;  2 450-454
• 4 Mendeloff A I. Thoughts on the epidemiology of diverticular disease.  Clin Gastroenterol. 1986;  15 855-877
• 5 McGuire H H, Haynes B W. Massive hemorrhage from diverticulosis of the colon: guidelines for therapy based on bleeding patterns observed in fifty cases.  Ann Surg. 1972;  175 847-853
• 6 Miura S, Kodaira S, Shatari T, Nishioka M, Hosoda Y, Hisa T K. Recent trends in diverticulosis of the right colon in Japan: retrospective review in a regional hospital.  Dis Colon Rectum. 2000;  43 1383-1389
• 7 Wells C. Diverticula of the colon.  Br J Radiol. 1949;  22 449-458
• 8 Painter M S, Truelove S C, Ardran G M, Tuckey M. Segmentation and the localization of intraluminal pressures in the human colon, with specific reference to the pathogenesis of colonic diverticula.  Gastroenterology. 1965;  49 169-177
• 9 Bassotti G, Germani U, Morelli A. Human colonic motility: physiologic aspects.  Int J Colorectal Dis. 1995;  10 173-180
• 10 Simpson J, Scholefield J H, Spiller R C. Pathogenesis of colonic diverticula.  Br J Surg. 2002;  89 546-554
• 11 Meyers M A, Alonso D R, Gray G F, Baer J W. Pathogenesis of bleeding colonic diverticulitis.  Gastroenterology. 1976;  71 577-583
• 12 Almy T P, Howell D S. Diverticular disease of the colon.  N Engl J Med. 1980;  302 324-331
• 13 McGuire Jr H H. Bleeding colonic diverticula. A reappraisal of natural history and management.  Ann Surg. 1994;  220 653-656
• 14 Zuckerman G R, Prakash C. Acute lower intestinal bleeding. Part II: etiology, therapy, and outcomes.  Gastrointest Endosc. 1999;  49 228-238
• 15 Jensen D M, Machicado G A, Jutabha R, Kovacs T O. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage.  N Engl J Med. 2000;  342 78-82
• 16 Nicholson M L, Neoptolemos J P, Sharp J F, Watkin E M, Fossard D P. Localization of lower gastrointestinal bleeding using in vivo technetium-99m-labelled red blood cell scintigraphy.  Br J Surg. 1989;  76 358-361
• 17 Ng D A, Opelka F G, Beck D E et al.. Predictive value of technetium Tc 99m-labeled red blood cell scintigraphy for positive angiogram in massive lower gastrointestinal hemorrhage.  Dis Colon Rectum. 1997;  40 471-477
• 18 Imbembo A L, Bailey R W. Diverticular disease of the colon. In: Sabiston DC Textbook of Surgery, 14th ed. Churchill Livingstone 1992: 910
• 19 Bandi R, Shetty P C, Sharma R P, Burke T H, Burke M W, Kastan D. Superselective arterial embolization for the treatment of lower gastrointestinal hemorrhage.  J Vasc Interv Radiol. 2001;  12 1399-1405
• 20 Darcy M. Treatment of lower gastrointestinal bleeding: vasopressin infusion versus embolization.  J Vasc Interv Radiol. 2003;  14 535-543
• 21 Kuo W T, Lee D E, Saad W E, Patel N, Sahler L T, Waldman D L. Superselective microcoil embolization for the treatment of lower gastrointestinal hemorrhage.  J Vasc Interv Radiol. 2003;  14 1503-1509
• 22 Ryan J M, Key S M, Dumbleton S A, Smith T P. Nonlocalized lower gastrointestinal bleeding: provocative bleeding studies with intraarterial tPA, heparin, and tolazoline.  J Vasc Interv Radiol. 2001;  12 1273-1277
• 23 Reilly M CT. Sigmoid myotomy: a new operation.  Proc R Soc Med. 1964;  57 56
• 24 Hodgson J. Transverse taeniamyotomy for diverticular disease.  Dis Colon Rectum. 1973;  16 283-289
• 25 Parkes B M, Obeid F N, Sorensen V J, Horst H M, Fath J J. The management of massive lower gastrointestinal bleeding.  Am Surg. 1993;  59 676-678
• 26 Setya V S, Singer J A, Minken S L. Subtotal colectomy as a last resort for unrelenting, unlocalized, lower gastrointestinal hemorrhage: experience with 12 cases.  Am Surg. 1992;  58 295-299
• 27 Wagner H E, Stain S C, Gilg M, Gertsch P. Systematic assessment of massive bleeding of the lower part of the gastrointestinal tract.  Surg Gynecol Obstet. 1992;  175 445-449
• 28 Kuhle W G, Sheiman R G. Detection of active colonic hemorrhage with use of helical CT: findings in a swine model.  Radiology. 2003;  228 743-752
• 29 Yamaguchi T, Yoshikawa K. Enhanced CT for initial localization of active lower gastrointestinal bleeding.  Abdom Imaging. 2003;  28 634-636