Abstract
Diagnosing diverticular hemorrhage of the colon using a standard colonoscopy under insufficient purging is highly difficult. Purging the colon with polyethylene glycol and using a transparent hood on the endoscope are essential for making an accurate diagnosis. Based on clinical observations including history of illness, history of medication, and sign of digital examination, we recommend contrast-enhanced computed tomography (CT) if diverticular hemorrhage is suspected. Based on CT imaging, we proceed to purge the colon and examine the colon using a colonoscopy with a transparent hood. The hood is gently pressed onto the perimeter of the diverticulum and mild suction is applied. This inverts the diverticular lumen and enables clear observation of the inside of the diverticulum. Furthermore, while applying continuous light pressure onto the diverticular perimeter using the hood, it is possible to introduce water into the channel of the endoscopy. Nonbleeding diverticula are readily cleansed by this purging technique, whereas bleeding diverticula are not easily cleansed. Thereby, purging serves to clearly differentiate offending from the nonoffending divericula. Eroded visible blood vessels are a sign of bleeding diverticula. For such offending diverticula, we suggest to directly apply clips onto the suction-inverted hemorrhagic diverticulum. We attempt to clip only the visible blood vessel. For cases with poor circulation or for cases with an unsuccessful endoscopic hemostasis, we suggest that interventional radiology as the next most effective treatment, though it has to be performed with care to reduce risk of complications.
