Features of bleeding colonic diverticuli:
(1) Bleeding is more common from diverticuli in the right colon but can occur anywhere.
(2) Bleeding may range from minor to massive with shock.
(3) Most bleeding stops spontaneously.
(4) Some patients have recurring episodes of hemorrhage.
(5) Severe bleeding may occur in a patient with a coagulopathy, anticoagulation therapy or antiplatelet drug therapy.
Colonoscopy may be able to locate the site of bleeding if bleeding is not severe. Angiography may be able to locate the site of bleeding if colonoscopy cannot be performed..
Injection of dilute epinephrine (1:10,000) about a bleeding diverticulum may stop the bleeding, at least temporarily. Thermocoagulation can be used if the bleeding vessel can be visualized.
Segmental resection may be indicated if:
(1) The bleeding is massive.
(2) The bleeding is recurrent or persistent.
(3) The site of bleeding can be identified or localized. Blind colon resection can be hazardous and may miss the site of bleeding.
(4) The patient has significant comorbid diseases.
Subtotal or total colectomy may be performed in exceptional cases.
