Initial Management and Colonoscopy for Colonic Diverticular Bleeding

Abstract

We conducted a review of the data of 39 patients were diagnosed as having colonic diverticular bleeding between July 2010 and December 2017 at our emergency and critical care center. The patients consisted of 28 males and 11 females, with an average age of 66.3 years. We investigated whether dynamic computed tomography (CT) on arrival at the hospital, prior to colonoscopy, is helpful to identify and treat colonic diverticular bleeding. Dynamic CT had been performed on arrival in 33 of the 36 patients (n=33). The identification rate of the source of colonic diverticular bleeding by first colonoscopy was 83％ in the extravasation group (n=12) and 43％ in the non-extravasation group (n=21). We treated 21 patients by endoscopic hemostasis, 12 patients by conservative therapy, 4 patients by interventional radiology (IVR) procedures, and 2 patients by surgery. To identify and treat colonic diverticular bleeding by colonoscopy, performance of dynamic CT in the patient on arrival, prior to colonoscopy, is recommended. In patients with frequent rebleeds after conservative therapy or endoscopic hemostasis, IVR procedures or surgical therapy should be considered.