[Anemia-inducing colonic diverticular hemorrhages]

20 patients with massive lower gastrointestinal bleeding caused by segmental or total colonic diverticular disease are presented. The bleeding source was localized by colonoscopy, angiography and intraoperatively in 5, 5 and 2 patients respectively. The hemorrhage occurred in the right colon in 9 patients and in the left colon in 3 patients. Due to ongoing bleeding 9 patients needed immediate surgery (7 right hemicolectomies, 1 left hemicolectomy, 1 sigmoidectomy). The median transfusion requirement of operated individuals was 14 units of blood. 2 (22%) patients died from postoperative complications. The remaining 7 patients had no recurrent bleeding during a median follow-up of 3.5 years (0.5-9 years). 11 patients with arrested bleeding (median transfusion requirement 3 units of blood) were treated conservatively. During a mean follow-up of 4.5 years (1.5-10 years) only one (9%) of the conservatively treated patients complained of recurrent bleeding requiring sigmoidectomy. We conclude that massive and ongoing hemorrhage (greater than 6 units of blood) occurs predominantly in right-sided colonic diverticula and requires immediate surgery. Arrested bleeding (transfusion requirements less than 6 units of blood) from colonic diverticula can be treated conservatively since operative mortality is high and recurrent bleeding is rare.