2017 Volume 59 Issue 2 Pages 184-189
A 78-year-old man presented to our emergency department with massive melena and hemorrhagic shock. Contrast-enhanced CT raised the suspicion of bleeding from the splenic flexure. Because it stopped bleeding naturally, conservative treatment was commenced, but he developed rebleeding and hemorrhagic shock three days after hospitalization. Because the hemorrhagic shock did not improve, we judged that endoscopic hemostasis would be difficult. Abdominal angiography could not detect bleeding diverticula, and emergency surgery was performed. We were able to detect the bleeding diverticulum with a huge visible vessel at the splenic flexure by intraoperative endoscopy, and were able to avoid colectomy by surgical ligation of the feeding artery and suturing all layers of the colonic wall.
Diverticular hemorrhage for which it is difficult to perform endoscopic hemostasis is rare, but we always have to assume that endoscopic hemostasis may be difficult. When we considered the complications and invasion of emergency surgery, this method was very useful.
