Acute lower gastrointestinal bleeding: SPECIFIC CAUSES OF LGI BLEEDING Part 2
Although most diverticula are located distal to the splenic flexure, 60% of those found to be bleeding at mesenteric angiography are located proximal to the splenic flexure. It is often mistakenly stated and believed that the bleeding is from diverticula (ie, multiple sites), when a single diverticulum is usually responsible for the bleeding, regardless of the number of diverticula. It is unclear why bleeding appears to be more common from right-sided than from left-sided colonic diverticula.
Treatment for recurrent bleeding (usually after the second mild to moderate episode) or for persistent bleeding from a diverticular source is traditionally surgical. Diagnostic studies are required to identify the site of colonic bleeding in an effort to guide the surgical resection. Endoscopic therapy can help identify the site in some patients and, in a select group, treat the bleeding. Although endoscopic electrocoagulation of a thin-walled diverticulum has been considered to carry a high risk, a recent small series reported success in three patients without complication. These patients had had recurrent bleeding from a diverticulum and were found to have a visible vessel at the edge of a diverticulum. They were treated with gold probe electrocautery, using a 50 W generator with a power setting of 20 W. The patients were managed on bulk agents and followed for a median of three years, with no evidence of rebleeding. Take advantage of this opportunity – buy cialis online pharmacy to enjoy lowest prices online.
Other endoscopic options include target suctioning and selective adrenaline injection into the base and sides of the diverticulum. Induced vasoconstriction, in addition to mechanical tamponade, likely contributes to successful endoscopic outcomes. Other techniques, such as the use of hemoclips, occasionally have been reported to be successful. More recently, endoscopic band ligation has even been successfully performed in a small number of patients with bleeding diverticuli. No controlled trials have been performed to assess critically these innovative techniques.