title: Massive and recurrent diverticular hemorrhage, risk factors and treatment.
abstract: OBJECTIVE
  Diverticular hemorrhage may be massive or recurrent, requiring surgical management. The aim of our study is to define risk factors that predict rebleeding or need for urgent operation in patients with diverticular hemorrhage.
  
  
  METHODS
  Retrospective study was conducted on patients who were admitted for diverticular hemorrhage. Data pertaining to patient and bleeding characteristics, method of diagnosis, blood transfusion and type of operation were collected. Multivariate analysis model compared patients who experienced single bleeding episode with those with recurrent episodes, and patients who underwent surgery with those who did not.
  
  
  RESULTS
  One hundred and four patients met the inclusion criteria. Thirty four patients experienced more than one bleeding episode. Ten patients needed surgery for recurrent bleeding. Five patients presented with hemodynamic instability, none of them required surgical treatment. Neither patients' comorbidity nor anticoagulant and antiaggregant treatments were associated with increased risk for recurrent hemorrhage. Diabetes mellitus was correlated with decreased risk for recurrent hemorrhage, OR = 0.21, (CI 95% (0.06-0.73)); p = 0.014. Independent risk factor for massive recurrent diverticular hemorrhage requiring surgery was right sided diverticulosis, OR = 4.6(CI 95% (2.1-19)); p = 0.006.
  
  
  CONCLUSIONS
  Right colon diverticulosis rather than patient characteristics and medical treatment should prompt for aggressive management with lower threshold for surgical intervention.
authors: Colorectal Surgery Unit, Rambam Health Care Campus, Haifa, Israel; Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.
authors: Hayim
authors: H
authors: Gilshtein
authors: Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.
authors: Yoram
authors: Y
authors: Kluger
authors: Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.
authors: Areen
authors: A
authors: Khoury
authors: Department of General Surgery, Hasharon Medical Center, Petah Tikva, Israel.
authors: Nidal
authors: N
authors: Issa
authors: Colorectal Surgery Unit, Rambam Health Care Campus, Haifa, Israel; Department of General Surgery, Rambam Health Care Campus, Haifa, Israel. Electronic address: wekhoury@gmail.com.
authors: Wisam
authors: W
authors: Khoury
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D004240:Diverticulum / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Diverticular hemorrhage; Operative treatment; Rebleeding