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Published on: October 16, 2013
Clinical Factors Associated with Severity of Colonic Diverticular Bleeding and Impact of Bleeding Site
Hirohito Amano1,2, Takatsugu Yamamoto1, Ken Ikusaka1
1Department of Medicine, Teikyo University School of Medicine, Tokyo 173-8605, Japan.
Insights
Serious colonic diverticular bleeding (CDB) risk factors and rebleeding patterns were identified. Confirmed CDB, especially from the right colon, is linked to higher transfusion and early rebleeding rates.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Interventional Radiology
Background:
- Colonic diverticular bleeding (CDB) incidence is rising, yet associated risk factors remain unclear.
- Understanding factors influencing serious CDB and rebleeding is crucial for patient management.
Purpose of the Study:
- To clarify factors associated with serious colonic diverticular bleeding (CDB).
- To identify predictors of early and late rebleeding in CDB patients.
Main Methods:
- Retrospective analysis of 329 hospitalized patients with confirmed or suspected CDB (2004-2021).
- Data collected on patient background, treatment, and clinical course, including transfusion and rebleeding events.
Main Results:
- Confirmed CDB, particularly right-sided, was associated with higher transfusion and invasive treatment rates.
- Anticoagulants and high shock index predicted red blood cell transfusion; confirmed CDB predicted early rebleeding.
- Hypertension, chronic kidney disease, and prior CDB predicted late rebleeding.
Conclusions:
- Confirmed CDB, especially right-sided, represents a significant risk for severe bleeding and early rebleeding.
- Distinct factors influence early versus late rebleeding, necessitating tailored management strategies.
Abstract:
Factors associated with serious colonic diverticular bleeding (CDB) are unclear, although the incidence of CDB has increased. We carried out this study to clarify factors associated with serious CDB and rebleeding. Subjects included 329 consecutive patients hospitalized for confirmed or suspected CDB between 2004 and 2021. Patients were surveyed regarding backgrounds, treatment, and clinical course. Of 152 with confirmed CDB, 112 showed bleeding from the right colon, and 40 did from the left colon. Patients received red blood cell transfusions in 157 (47.7%), interventional radiology in 13 (4.0%), and surgery in 6 (1.8%) cases. Early rebleeding within one month occurred in 75 (22.8%) patients, and late rebleeding within one year occurred in 62 (18.8%). Factors associated with red blood cell transfusion included confirmed CDB, anticoagulants, and high shock index. The only factor related to interventional radiology or surgery was confirmed CDB, which was also associated with early rebleeding. Late rebleeding was associated with hypertension, chronic kidney disease and past CDB. Right CDB showed higher rates of transfusion and invasive treatment than left CDB. Confirmed CDB had high frequencies of transfusion, invasive treatment, and early rebleeding. Right CDB seemed to be a risk for serious disease. Factors related to late rebleeding were different from those related to early rebleeding of CDB.
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