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[Massive hemorrhage caused by colonic diverticulosis]
P L Colombo1, A Todde, M Belisomo
1Cattedra di Chirurgia Apparato Digerente, Università di Pavia-I.R.C.C.S. Policlinico San Matteo.
Annali Italiani Di Chirurgia
|January 1, 1994
Summary
Massive colonic bleeding from diverticular disease is challenging. Angioarchitecture of diverticular walls contributes to hemorrhage, requiring advanced diagnostic and surgical approaches for effective management.
Area of Science:
- Gastroenterology
- Abdominal Surgery
- Vascular Biology
Background:
- Massive colonic hemorrhage from diverticular disease presents significant challenges in emergency abdominal surgery.
- The pathogenesis of bleeding diverticulosis is linked to the unique angioarchitecture of the colonic diverticular wall, where vasa recta penetration can lead to arterial rupture.
Purpose of the Study:
- To review the diagnostic modalities and surgical management strategies for massive colonic hemorrhage secondary to diverticular disease.
Main Methods:
- Review of diagnostic techniques including barium enema, colonoscopy, radionuclide bleeding scans, and emergency arteriography.
- Discussion of surgical interventions such as segmental resection, subtotal colectomy, and intraoperative management strategies.
Main Results:
- Colonoscopy has positive findings in 41.5%-83.7% of patients; radionuclide scans show 86%-94% sensitivity.
- Emergency arteriography localizes bleeding sources in 58%-86% of cases and is successful with vasopressin or embolization in 47%-92% of patients.
- Blind resections in elderly patients have high rebleeding rates (>60%) and mortality (30%).
Conclusions:
- Diagnostic imaging like arteriography is crucial for localizing bleeding in diverticular disease.
- Surgical treatment varies from segmental resection for localized bleeding to subtotal colectomy for diffuse or right-sided hemorrhage.
- Management decisions must consider patient factors, bleeding localization, and potential risks of rebleeding and mortality.