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Pathogenesis of bleeding colonic diverticulosis: new concepts
CRC Critical Reviews in Diagnostic Imaging
|January 1, 1978
Summary
Colon diverticulosis, common in older adults on low-roughage diets, can cause massive bleeding. Right-sided diverticulosis is a frequent cause, linked to chronic injury of blood vessels within the diverticulum.
Area of Science:
- Gastroenterology
- Vascular Medicine
Background:
- Colon diverticulosis is a prevalent condition in aging populations, often associated with diets low in fiber.
- High intraluminal pressures in the colon contribute to the formation and potential complications of diverticula.
Purpose of the Study:
- To elucidate the pathophysiology of massive colonic bleeding secondary to diverticulosis.
- To highlight the role of right-sided diverticulosis in significant hemorrhage.
Main Methods:
- Review of pathological mechanisms leading to diverticular rupture and bleeding.
- Discussion of diagnostic modalities, emphasizing selective angiography.
- Exploration of emerging interventional treatments.
Main Results:
- Massive colonic bleeding is most commonly attributed to right-sided diverticulosis.
- Hemorrhage results from chronic injury and subsequent rupture of vasa recta within the diverticulum's submucosa.
- Vessel wall weakening involves intimal fibrosis, elastic lamina fragmentation, and smooth muscle atrophy.
Conclusions:
- Understanding the vascular basis of bleeding in diverticulosis is crucial for effective management.
- Selective angiography is the preferred diagnostic method.
- Pharmacological angiography and embolization offer promising, less invasive treatment options compared to surgery.