Diverticular bleeding occasionally can be severe and uncontrollable by standard methods. Barium impaction can be used to control bleeding when all else fails.
Patient selection: uncontrolled diverticular bleeding (cannot be controlled by angiography, endoscopy or other methods) and surgery contraindicated
Barium contrast material is insoluble material that will solidify if the water is removed.
To control diverticular bleeding the barium is instilled into the affected segment of colon and allowed to inspissate. The tamponades the bleeding. Once the bleeding is under control then the impacted barium is removed.
Since the goal is to inspissate the contrast material, the contrast material should contain as little water as possible yet still be deliverable to the needed site. A balloon may be needed to keep the material in the right location.
Impaction therapy results in temporary bowel obstruction so some advanced planning is required.
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