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Colonic diverticular bleeding with comorbid diseases may need elective colectomy
Chao-Yang Chen1, Chang-Chieh Wu, Shu-Wen Jao
1Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, 6F, No. 325, Sec. 2, Cheng- Kung Road, Nei-Hu 114, Taipei, Taiwan, Republic of China.
Insights
Urgent colectomy for colonic diverticular bleeding carries significant risks, especially for patients with comorbidities. Early elective surgery may improve outcomes for high-risk individuals.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Clinical Research
Background:
- Colonic diverticular bleeding often resolves with conservative management.
- Surgery is reserved for severe, recurrent, or life-threatening cases.
- Identifying risk factors for colectomy in diverticular bleeding is crucial.
Purpose of the Study:
- To identify risk factors associated with colectomy for colonic diverticular bleeding.
- To evaluate outcomes of surgical intervention for this condition.
Main Methods:
- Retrospective chart review of 73 patients with colonic diverticular bleeding (1997-2005).
- Univariate and multivariate logistic regression analyses were employed.
- Risk factors correlating to colectomy were identified.
Main Results:
- 86.3% of patients were managed conservatively; 13.7% required urgent colectomy.
- Comorbidities and high blood transfusion requirements were significant risk factors for urgent colectomy.
- Mortality was 4.11% overall, and 20% in the urgent colectomy group.
Conclusions:
- Preoperative comorbidities increase operative risk and negatively impact outcomes in urgent colectomy for diverticular bleeding.
- Early elective colectomy may be beneficial for patients with diverticular bleeding and comorbidities, particularly diabetes and gout.
- This suggests a need for proactive surgical planning in select high-risk patients.
Background:
Colonic diverticular bleeding can usually be managed with conservative treatment. However, in a selected group of patients under conditions of recurrent, persistent bleeding influencing quality of life or causing life-threatening shock, it should be managed with surgery. This is a retrospective study to clarify the risk factors relating to colectomy for colonic diverticular bleeding.
Methods:
Between 1997 and 2005, a retrospective chart review of 73 patients with colonic diverticular bleeding was undertaken. Univariate and multivariate logistic regression analyses were performed to identify the relevant risk factors correlating to colectomy.
Results:
The mean age of the 73 patients was 70 years (range, 22-90 years). Most colonic diverticular bleeding could be managed with conservative treatment (n = 63, 86.3%), and urgent colectomy was performed in ten patients (13.7%). The bleeding site could not be well identified in six of those ten patients and so underwent total abdominal colectomy with ileorectal anastomosis, and the other four underwent right hemicolectomy after a diagnosis of right-sided colon diverticula with bleeding. There were two deaths in the surgical group and one death in the nonsurgical group. The overall mortality rate in the series was 4.11% and 20% among patients undergoing urgent colectomy. Multiple logistic regression analysis showed that the presence of comorbidities and daily maximum blood transfusion requirement were risk factors for urgent colectomy for colonic diverticular bleeding.
Conclusion:
Preoperative comorbid diseases may increase operative risk in urgent surgery, and the outcome is poor. To avoid high mortality and morbidity relating to the urgent colectomy, we suggest that patients of colonic diverticular bleeding with comorbid diseases, especially subgroups of patients with diabetes and gouty arthritis, may need early elective colectomy.
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