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Bleeding colonic diverticula
1Memphis Gastroenterology Group, Germantown, TN 38138, USA. mlewis@memphisgastro.com
Insights
Lower gastrointestinal bleeding often stems from ruptured blood vessels within colonic diverticula. While typically self-resolving, understanding this common cause is crucial for elderly patients.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Vascular Medicine
Background:
- Diverticula of the large intestine are a frequent cause of lower gastrointestinal (GI) bleeding.
- This bleeding, ranging from occult to massive, often originates from the right colon, despite most diverticula being in the left colon.
- Rupture of the vasa recta, eccentrically located toward the diverticular lumen, is the primary cause.
Purpose of the Study:
- To summarize the etiology, presentation, and management of lower GI bleeding secondary to colonic diverticulosis.
- To highlight the prevalence and common sources of diverticular hemorrhage.
- To discuss associated risk factors and treatment considerations.
Main Methods:
- Review of existing literature on diverticular disease and lower GI bleeding.
- Analysis of the pathophysiology of bleeding from diverticula.
- Synthesis of information on diagnostic and therapeutic approaches.
Main Results:
- Lower GI bleeding occurs in 10-30% of GI bleeds, predominantly in the elderly, with diverticular disease being a major contributor.
- Right-sided colonic hemorrhage is common, despite the majority of diverticula residing in the left colon.
- Spontaneous cessation of bleeding occurs in approximately 90% of cases; inflammation is usually absent.
Conclusions:
- Diverticula are a significant cause of lower GI bleeding, particularly in older adults.
- While often self-limiting, factors like hypertension, anticoagulation, diabetes, and ischemic heart disease may be associated.
- Conservative management is preferred due to high recurrence rates with invasive interventions like angiography and surgery.
Abstract:
Diverticula of the large intestine constitute a common source of lower gastrointestinal (GI) bleeding both occult and massive and are a particular common cause of right-sided colonic hemorrhage. Bleeding in all cases is due to rupture of the underlying vasa rectum. In all cases, rupture of the artery is not circumferential, but eccentric having occurred toward the lumen of the diverticula. It is rare to see either acute or chronic diverticulitis associated with this situation. Lower GI bleeding is frequent in the elderly secondary to diverticular disease and occurs in about 10% to 30% GI bleeds and actually is much less frequent than upper GI bleeding. Diverticular disease actually is uncommon in people under the age of 40. However, by the age of 50 almost one-third of the population has diverticulosis. Ninety percent of the diverticula are in the left colon, but bleeding is from the right colon at least 50% of the time. Diverticular hemorrhage will cease spontaneously in about 90% cases. Most often, there is no inflammatory process around the diverticular bleeding. Hypertension even may be a predisposing factor. Also anticoagulation, diabetes mellitus, and ischemic heart disease are associated with diverticular hemorrhage. As far as treatment is concerned, conservative therapy is usually the best approach. One would like to avoid angiography and surgery if at all possible. There is a significant recurrence of bleeding in those patients who are treated even with angiography and with surgery. Etiology of the bleeding is not really well understood and the diagnosis and treatment is quite difficult in some situations.
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