| [ Summary ] |
Clinical presentation of diverticular bleeding is red to bright red, and occasionally also red-brown stools usually without abdominal pain. In order to diagnose diverticular bleeding, it is necessary both to identify diverticula via colonoscopy or by contrast enema, and disprove the existence of a colonic cancer or ischemic colitis. Angiography and radioisotope studies as well as colonoscopy are also useful to demonstrate the site of colon bleeding. The definitive bleeding diverticulum which is identified via colonoscopy could be treated by local injection of hypertonic saline or hypertonic glucose solution. When the site of colon bleeding is identified by angiography, subsequent therapeutic procedures including transcatheter arterial embolization or transcatheter arterial infusion are effective to control bleeding. A conservative policy in the treatment of diverticular bleeding is advocated, however, bleeding in amounts over 1000ml requires blood transfusion, and patients whose vital signs are unstable in spite of blood transfusion are candidates for an emergency operation. Surgery for diverticular bleeding is a segmental colectomy of the area assumed to possess the bleeding site. Once diverticular bleeding stops by conservative treatments, prophylactic colectomy is not necessary. |