2019 Volume 52 Issue 10 Pages 590-598
A 77-year-old man who has been treated by endoscopic hemostasis for frequent rebleeding of colonic diverticula for four years, underwent elective laparoscopic surgery. First, intraoperative colonoscopy was performed to identify the culprit diverticulum, to which several endoscopic hemostatic clips had been applied preoperatively. Then, the culprit diverticulum was sutured laparoscopically under the observation of colonoscopy, and local resection was performed by endoscopic linear stapler while the sutured strings were pulled up by grasping forceps. He was discharged with good postoperative course and has been followed up one-year after surgery. Japanese guidelines for the management of colonic diverticulosis (diverticular bleeding, diverticulitis) established by the Japanese Gastrointesitinal Association recommends colectomy for diverticular bleeding resistant to endoscopic hemostasis and interventional radiology, following the preoperative bleeding source identification. We propose it is desirable to reduce the extent of colectomy and counteract the surgical stress, because colonic diverticulum is a benign disease. The present procedure may have benefits such as reduction of operative risks and avoidance of massive colectomy. To the best of our knowledge, no similar cases have previously been reported in the literature.
