Massive and Recurrent Diverticular Hemorrhage, Risk Factors and Treatment

• Published in: International journal of surgery (London, England) Vol. 33; pp. 136 - 139
• Main Authors: Gilshtein, Hayim, MD, Kluger, Yoram, MD, Khoury, Areen, MD, Issa, Nidal, MD, Khoury, Wisam, MD
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2016
• Subjects: Adult; Aged; Aged, 80 and over; Blood Transfusion; Diverticular hemorrhage; Diverticulum - etiology; Diverticulum - therapy; Female; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - therapy; Humans; Male; Middle Aged; Operative treatment; Rebleeding; Retrospective Studies; Risk Factors; Surgery; Rebleeding; Operative treatment; Diverticular hemorrhage
• ISSN: 1743-9191; 1743-9159
• DOI: 10.1016/j.ijsu.2016.07.076

Abstract Aim Diverticular hemorrhage may be massive or recurrent, requiring surgical management. The aim of our study is to define risk factors that predict rebleeding or need for urgent operation in patients with diverticular hemorrhage. Methods Retrospective study was conducted on patients who were admitted for diverticular hemorrhage. Data pertaining to patient and bleeding characteristics, method of diagnosis, blood transfusion and type of operation were collected. Multivariate analysis model compared patients who experienced single bleeding episode with those with recurrent episodes, and patients who underwent surgery with those who did not. Results One hundred and four patients met the inclusion criteria. Thirty four patients experienced more than one bleeding episode. Ten patients needed surgery for recurrent bleeding. Five patients presented with hemodynamic instability, none of them required surgical treatment. Neither patients' comorbidity nor anticoagulant and antiaggregant treatments were associated with increased risk for recurrent hemorrhage. Diabetes mellitus was correlated with decreased risk for recurrent hemorrhage, OR=0.21,(CI 95% (0.06-0.73));p=0.014. Independent risk factor for massive recurrent diverticular hemorrhage requiring surgery was right sided diverticulosis, OR=4.6(CI 95% (2.1-19)); p=0.006. Conclusions Right colon diverticulosis rather than patient characteristics and medical treatment should prompt for aggressive management with lower threshold for surgical intervention.