Management of lower gastrointestinal bleeding in colonic diverticular disease

To evaluate the clinical course, diagnostic approach, therapeutic measures and results, in a series of 13 patients with colonic bleeding diverticula.

From 1973 to 1995, 72 patients were admitted with the diagnosis of lower gastroin testinal bleeding. Thirteen presented a colonic diverticula bleeding. Mean age was 65.2 years. Medical history, symptoms, diagnosis, treatment (conservative or surgical) and pathology were recorded.

Main bleeding time was 3 days. Eight patients needed blood transfusion. All patients underwent colonoscopic examination and it was diagnostic in every patient. Four patients underwent surgery: one case, because of massive hemorrhage and the other three cases due to bleeding recurrence. Pancolectomy was performed in one patient, ileal resection in another and the other two were treated with a sigmoidectomy and a left hemicolectomy. Pathology analysis corroborated colonic diverticula diagnosis. There was no postoperative mortality. Bleeding recurrence did not occur either in postoperative period or in the follow-up.

Colonic diverticular bleeding usually stops spontaneously, obtaining high rates of preoperative diagnosis with colonoscopy. Less than a third of the cases requires surgical resection.