Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage.
BACKGROUND
Although endoscopy is often used to diagnose and treat acute upper gastrointestinal bleeding, its role in the management of diverticulosis and lower gastrointestinal bleeding is uncertain.


METHODS
We studied the role of urgent colonoscopy in the diagnosis and treatment of 121 patients with severe hematochezia and diverticulosis. All patients were hospitalized, received blood transfusions as needed, and received a purge to rid the colon of clots, stool, and blood. Colonoscopy was performed within 6 to 12 hours after hospitalization or the diagnosis of hematochezia. Among the first 73 patients, those with continued diverticular bleeding underwent hemicolectomy. For the subsequent 48 patients, those requiring treatment received therapy, such as epinephrine injections or bipolar coagulation, through the colonoscope.


RESULTS
Of the first 73 patients, 17 (23 percent) had definite signs of diverticular hemorrhage (active bleeding in 6, nonbleeding visible vessels in 4, and adherent clots in 7). Nine of the 17 had additional bleeding after colonoscopy, and 6 of these required hemicolectomy. Of the subsequent 48 patients, 10 (21 percent) had definite signs of diverticular hemorrhage (active bleeding in 5, nonbleeding visible vessels in 2, and adherent clots in 3). An additional 14 patients in this group (29 percent) were presumed to have diverticular bleeding because although they had no stigmata of diverticular hemorrhage, no other source of bleeding was identified. The other 24 patients (50 percent) had other identified sources of bleeding. All 10 patients with definite diverticular hemorrhage were treated endoscopically; none had recurrent bleeding or required surgery.


CONCLUSIONS
Among patients with severe hematochezia and diverticulosis, at least one fifth have definite diverticular hemorrhage. Colonoscopic treatment of such patients with epinephrine injections, bipolar coagulation, or both may prevent recurrent bleeding and decrease the need for surgery.
Jensen
D M
DM
Digestive Disease Research Center, University of California at Los Angeles Center for the Health Sciences, and the Veterans Affairs Greater Los Angeles Healthcare System, 90073-1003, USA. djensen@med1.medsch.ucla.edu
Machicado
G A
GA
Jutabha
R
R
Kovacs
T O
TO
D000208:Acute Disease; D000368:Aged; D016009:Chi-Square Distribution; D003082:Colectomy; D003108:Colonic Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D003113:Colonoscopy; D004240:Diverticulum / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D004837:Epinephrine / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006801:Humans; D011446:Prospective Studies; D012008:Recurrence; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D004837:Epinephrine