title: Efficacy of Contrast-enhanced Computed Tomography for the Treatment Strategy of Colonic Diverticular Bleeding.
abstract: OBJECTIVE
  Diverticular bleeding is the most common cause of acute lower gastrointestinal bleeding, and its incidence has recently increased. However, the treatment strategy of diverticular bleeding has not yet been established. The aim of the study was to investigate the efficacy of contrast-enhanced computed tomography (CECT) to determine the indication for urgent colonoscopy to achieve hemostasis.
  
  
  METHODS
  A total of 124 patients diagnosed with diverticular bleeding between 2012 and 2013 in our hospital were analyzed. The clinical behavior, factors related to detecting bleeding diverticula, and risk factors for early rebleeding of diverticular bleeding were evaluated.
  
  
  RESULTS
  Clinical behavior: Bleeding diverticula were identified in 23 of 124 (19%) patients and most of them (16/23; 70%) were located in the ascending colon. Hemostasis was achieved in all 23 cases, however, six (26%) developed early rebleeding. Factors for detecting bleeding diverticula: In patients in whom extravasation was detected using CECT, the endoscopic detection rate of bleeding diverticula was 60% (12/20), while bleeding diverticula were detected in only 31% (11/35) of patients in whom extravasation was not detected using CECT (p<0.05). The interval between the first hematochezia and colonoscopy in which the bleeding point was detected by colonoscopy (median 23.5 hours) was shorter than that in which bleeding diverticula were not detected (median 43.6 hours) (p<0.01). Risk factors for short term rebleeding: Using a univariate analysis, atherosclerotic comorbidity, anti-inflammatory drugs including low-dose aspirin, antithrombotic agents, vital signs on admission, hemoglobin level on hospitalization, and extravasation on CECT were not found to be significant risk factors.
  
  
  CONCLUSIONS
  The finding of extravasation on CECT is the most important factor for identifying and treating bleeding diverticula by colonoscopy. In such cases, urgent colonoscopy is recommended.
authors.affiliation: Department of Gastroenterology, Kasugai Municipal Hospital, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Sugiyama
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Hirata
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kojima
authors.forename: Takuya
authors.initials: T
authors.lastname: Kanno
authors.forename: Mikitoshi
authors.initials: M
authors.lastname: Kimura
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Okuda
authors.forename: Kenichi
authors.initials: K
authors.lastname: Haneda
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Ikeuchi
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Morikawa
authors.forename: Hisato
authors.initials: H
authors.lastname: Mochizuki
authors.forename: Hiroki
authors.initials: H
authors.lastname: Takada
authors.forename: Satoshi
authors.initials: S
authors.lastname: Sobue
mesh_terms: D000368:Aged; D001241:Aspirin; D003108:Colonic Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D003113:Colonoscopy; D003287:Contrast Media; D004241:Diverticulum, Colon / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000009:adverse effects
chemical_list: D003287:Contrast Media; D001241:Aspirin