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[Colonic diverticular haemorrhage]
1Service de chirurgie digestive et endocrinienne, Hôpitaux universitaires de Strasbourg, hôpital civil, Strasbourg.
Bleeding related to diverticular disease occurs in 10 to 30% of patients suffering from diverticular disease. Haemorrhage varies from occult to massive bleeding. Bleeding is related to mechanical aggression of the artery in the wall of a diverticulum. Bleeding prevalence is not exactly known. In 1 to 7% of cases, massive bleeding is observed; diverticular disease is thus the most common cause of major lower gastrointestinal tract haemorrhage, followed by angiodysplasias. Although 95% of diverticular involve the sigmoid colon, more than 50% of bleeding diverticular occur in the right colon. Classically, presentation of bleeding is sudden without any inflammatory diverticulitis. Bleeding from diverticula stops spontaneously in 80% of cases. For definite diagnosis, selective abdominal angiography during bleeding phase is the procedure of choice. Other explorations are not contributive. Most haemorrhages have a benign outcome. Massive, persistent or recurrent haemorrhage should benefit from surgical procedure. In case of active bleeding in which diverticular origin has been validated by angiography, intra-arterial perfusion of vasopressor agents may be attempted, as a temporary treatment before delayed colonic resection. Segmental colectomy usually prevents recurrent haemorrhage when site of diverticular bleeding has not been identified with precision by angiography. Subtotal colectomy should only be used in the last resort. Extent of surgery will be based on likely origin of bleeding.
Bleeding related to diverticular disease occurs in 10 to 30% of patients suffering from diverticular disease. Haemorrhage varies from occult to massive bleeding. Bleeding is related to mechanical aggression of the artery in the wall of a diverticulum. Bleeding prevalence is not exactly known. In 1 to 7% of cases, massive bleeding is observed; diverticular disease is thus the most common cause of major lower gastrointestinal tract haemorrhage, followed by angiodysplasias. Although 95% of diverticular involve the sigmoid colon, more than 50% of bleeding diverticular occur in the right colon. Classically, presentation of bleeding is sudden without any inflammatory diverticulitis. Bleeding from diverticula stops spontaneously in 80% of cases. For definite diagnosis, selective abdominal angiography during bleeding phase is the procedure of choice. Other explorations are not contributive. Most haemorrhages have a benign outcome. Massive, persistent or recurrent haemorrhage should benefit from surgical procedure. In case of active bleeding in which diverticular origin has been validated by angiography, intra-arterial perfusion of vasopressor agents may be attempted, as a temporary treatment before delayed colonic resection. Segmental colectomy usually prevents recurrent haemorrhage when site of diverticular bleeding has not been identified with precision by angiography. Subtotal colectomy should only be used in the last resort. Extent of surgery will be based on likely origin of bleeding.