Acute diverticulitis complicated by massive lower gastrointestinal bleeding: a rare diagnostic challenge

Area of Science:

• Gastroenterology
• Interventional Radiology
• Surgical Case Report

Background:

• Acute sigmoid diverticulitis can lead to pericolonic abscess formation.
• Complicated diverticulitis poses risks, including hemorrhage, which can be life-threatening.
• Hemorrhage from diverticular abscesses into adjacent vasculature is a rare but serious complication.

Purpose of the Study:

• To report a rare case of sigmoid diverticulitis with an abscess complicated by hemorrhage.
• To illustrate the successful management of arterial hemorrhage secondary to a diverticular abscess.
• To highlight the role of interventional radiology in managing such critical bleeding events.

Main Methods:

• A 70-year-old male with acute sigmoid diverticulitis and a large pericolonic abscess was managed non-operatively.
• Hemorrhagic shock developed due to massive hematochezia, prompting urgent investigation.
• Diagnostic angiography revealed abscess erosion into the left inferior epigastric artery, treated with angioembolization.

Main Results:

• Angiography confirmed hyperaemia around the abscess cavity, indicative of vascular involvement.
• Successful angioembolization of the left inferior epigastric artery achieved hemostasis.
• The patient stabilized, recovered from the hemorrhage, and was discharged for elective sigmoidectomy.

Conclusions:

• Erosion of a diverticular abscess into the left inferior epigastric artery can cause severe hemorrhage.
• Interventional radiology, specifically angioembolization, is a crucial modality for achieving hemostasis in such cases.
• Prompt diagnosis and endovascular intervention can prevent mortality and allow for definitive surgical management.