Skip to main content
SpringerLink
Log in

Management of Colonic Diverticular Bleeding and Bleeding Colitis

  • Chapter
  • First Online:
Gastrointestinal Bleeding

  • 1042 Accesses

Abstract

Colonic diverticular bleeding and colitis account for the majority of cases of lower gastrointestinal bleeding, with diverticular bleeding being by far the most common etiology. In contrast to diverticulitis, colonic diverticular bleeding most commonly originates in the ascending colon. Management of diverticular bleeding should start with adequate volume resuscitation, followed by colonoscopic localization and control of the bleeding site. Selective angiography may be employed for those who cannot undergo colonoscopy or underwent unsuccessful colonoscopic evaluation or treatment. Surgery is reserved for intractable diverticular bleeding. Bleeding from colitis is usually intermittent and self-limited. In hemodynamically stable patients with colitis bleeding, treatment should be aimed at control of the source of inflammation. If hemodynamic stability is compromised or if bleeding is severe, angiography and/or emergent resection should be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Longstreth GF. Epidemiology and outcome of patients hospitalized with acute lower gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1997;92(3):419–24.

    CAS  PubMed  Google Scholar 

  2. Meyers MA, Alonso DR, Gray GF, Baer JW. Pathogenesis of bleeding colonic diverticulosis. Gastroenterology. 1976;71(4):577–83.

    CAS  PubMed  Google Scholar 

  3. Stollman N, Raskin JB. Diverticular disease of the colon. Lancet. 2004;363(9409):631–9.

    Article  PubMed  Google Scholar 

  4. Painter NS. Diverticular disease of the colon. The first of the Western diseases shown to be due to a deficiency of dietary fibre. S Afr Med J. 1982;61(26):1016–20.

    CAS  PubMed  Google Scholar 

  5. Golder M et al. Smooth muscle cholinergic denervation hypersensitivity in diverticular disease. Lancet. 2003;361(9373):1945–51.

    Article  CAS  PubMed  Google Scholar 

  6. Wess L, Eastwood MA, Wess TJ, Busuttil A, Miller A. Cross linking of collagen is increased in colonic diverticulosis. Gut. 1995;37(1):91–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. McGuire Jr HH, Haynes Jr BW. Massive hemorrhage for diverticulosis of the colon: guidelines for therapy based on bleeding patterns observed in fifty cases. Ann Surg. 1972;175(6):847–55.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Casarella WJ, Kanter IE, Seaman WB. Right-sided colonic diverticula as a cause of acute rectal hemorrhage. N Engl J Med. 1972;286(9):450–3.

    Article  CAS  PubMed  Google Scholar 

  9. Wong SK, Ho YH, Leong AP, Seow-Choen F. Clinical behavior of complicated right-sided and leftsided diverticulosis. Dis Colon Rectum. 1997;40(3):344–8.

    Article  CAS  PubMed  Google Scholar 

  10. Gostout CJ et al. Acute gastrointestinal bleeding. Experience of a specialized management team. J Clin Gastroenterol. 1992;14(3):260–7.

    Article  CAS  PubMed  Google Scholar 

  11. Laine L, Shah A. Randomized trial of urgent vs. elective colonoscopy in patients hospitalized with lower GI bleeding. Am J Gastroenterol. 2010;105(12):2636–41. quiz 2642.

    Article  PubMed  Google Scholar 

  12. Green BT et al. Urgent colonoscopy for evaluation and management of acute lower gastrointestinal hemorrhage: a randomized controlled trial. Am J Gastroenterol. 2005;100(11):2395–402.

    Article  PubMed  Google Scholar 

  13. Wilcox CM, Clark WS. Causes and outcome of upper and lower gastrointestinal bleeding: the Grady Hospital experience. South Med J. 1999;92(1):44–50.

    Article  CAS  PubMed  Google Scholar 

  14. Angtuaco TL, Reddy SK, Drapkin S, Harrell LE, Howden CW. The utility of urgent colonoscopy in the evaluation of acute lower gastrointestinal tract bleeding: a 2-year experience from a single center. Am J Gastroenterol. 2001;96(6):1782–5.

    Article  CAS  PubMed  Google Scholar 

  15. Zuckerman GR, Prakash C. Acute lower intestinal bleeding. Part II: etiology, therapy, and outcomes. Gastrointest Endosc. 1999;49(2):228–38.

    Article  CAS  PubMed  Google Scholar 

  16. Navaneethan U, Njei B, Venkatesh PG, Sanaka MR. Timing of colonoscopy and outcomes in patients with lower GI bleeding: a nationwide population-based study. Gastrointest Endosc. 2014;79(2):297–306. e12.

    Article  PubMed  Google Scholar 

  17. Nusbaum M, Baum S. Radiographic demonstration of unknown sites of gastrointestinal bleeding. Surg Forum. 1963;14:374–5.

    CAS  PubMed  Google Scholar 

  18. Zuckerman DA, Bocchini TP, Birnbaum EH. Massive hemorrhage in the lower gastrointestinal tract in adults: diagnostic imaging and intervention. AJR Am J Roentgenol. 1993;161(4):703–11.

    Article  CAS  PubMed  Google Scholar 

  19. Jensen DM, Machicado GA, Jutabha R, Kovacs TO. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med. 2000;342(2):78–82.

    Article  CAS  PubMed  Google Scholar 

  20. Vernava 3rd AM, Moore BA, Longo WE, Johnson FE. Lower gastrointestinal bleeding. Dis Colon Rectum. 1997;40(7):846–58.

    Article  PubMed  Google Scholar 

  21. Leitman IM, Paull DE, Shires 3rd GT. Evaluation and management of massive lower gastrointestinal hemorrhage. Ann Surg. 1989;209(2):175–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Baum S et al. Selective mesenteric arterial infusions in the management of massive diverticular hemorrhage. N Engl J Med. 1973;288(24):1269–72.

    Article  CAS  PubMed  Google Scholar 

  23. Eaton AC. Emergency surgery for acute colonic haemorrhage-a retrospective study. Br J Surg. 1981;68(2):109–12.

    Article  CAS  PubMed  Google Scholar 

  24. Truelove SC, Witts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J. 1955;2(4947):1041–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Hanauer SB. Inflammatory bowel disease. N Engl J Med. 1996;334(13):841–8.

    Article  CAS  PubMed  Google Scholar 

  26. Jones JH, Chapman M. Definition of megacolon in colitis. Gut. 1969;10(7):562–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Katz JA. Medical and surgical management of severe colitis. Semin Gastrointest Dis. 2000;11(1):18–32.

    CAS  PubMed  Google Scholar 

  28. Present DH. Toxic megacolon. Med Clin North Am. 1993;77(5):1129–48.

    Article  CAS  PubMed  Google Scholar 

  29. Hyman NH, Cataldo P, Osler T. Urgent subtotal colectomy for severe inflammatory bowel disease. Dis Colon Rectum. 2005;48(1):70–3.

    Article  PubMed  Google Scholar 

  30. Chavalitdhamrong D et al. Ischemic colitis as a cause of severe hematochezia: risk factors and outcomes compared with other colon diagnoses. Gastrointest Endosc. 2011;74(4):852–7.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Steele SR et al. Practice parameters for the management of Clostridium difficile infection. Dis Colon Rectum. 2015;58(1):10–24.

    Article  PubMed  Google Scholar 

  32. Jobe BA, Grasley A, Deveney KE, Deveney CW, Sheppard BC. Clostridium difficile colitis: an increasing hospital-acquired illness. Am J Surg. 1995;169(5):480–3.

    Article  CAS  PubMed  Google Scholar 

  33. Grundfest-Broniatowski S et al. Clostridium difficile colitis in the critically ill. Dis Colon Rectum. 1996;39(6):619–23.

    Article  CAS  PubMed  Google Scholar 

  34. Morris JB, Zollinger Jr RM, Stellato TA. Role of surgery in antibiotic-induced pseudomembranous enterocolitis. Am J Surg. 1990;160(5):535–9.

    Article  CAS  PubMed  Google Scholar 

  35. Kochhar R et al. Radiation-induced proctosigmoiditis. Prospective, randomized, double-blind controlled trial of oral sulfasalazine plus rectal steroids versus rectal sucralfate. Dig Dis Sci. 1991;36(1):103–7.

    Article  CAS  PubMed  Google Scholar 

  36. Kochhar R, Sriram PV, Sharma SC, Goel RC, Patel F. Natural history of late radiation proctosigmoiditis treated with topical sucralfate suspension. Dig Dis Sci. 1999;44(5):973–8.

    Article  CAS  PubMed  Google Scholar 

  37. Chun M et al. Rectal bleeding and its management after irradiation for uterine cervical cancer. Int J Radiat Oncol Biol Phys. 2004;58(1):98–105.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Mohamed A. Adam M.D. & Zhifei Sun M.D.

  2. Division of Colon and Rectal Surgery, Duke University Medical Center, Durham, NC, USA

    John Migaly

Authors
  1. Mohamed A. Adam M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhifei Sun M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Migaly
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John Migaly .

Editor information

Editors and Affiliations

  1. Department of Surgery, Stony Brook Medicine, Stony Brook, New York, USA

    Aurora D. Pryor

  2. Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA

    Theodore N. Pappas

  3. Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA

    M. Stanley Branch

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing AG

About this chapter

Cite this chapter

Adam, M.A., Sun, Z., Migaly, J. (2016). Management of Colonic Diverticular Bleeding and Bleeding Colitis. In: Pryor, A., Pappas, T., Branch, M. (eds) Gastrointestinal Bleeding. Springer, Cham. https://doi.org/10.1007/978-3-319-40646-6_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-40646-6_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-40644-2

  • Online ISBN: 978-3-319-40646-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation