Browse > Article
http://dx.doi.org/10.3904/kjm.2013.85.6.571

Diagnosis and Treatment of Diverticular Bleeding and Perforation  

Keum, Bora (Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine)
Publication Information
The Korean Journal of Medicine / v.85, no.6, 2013 , pp. 571-577 More about this Journal
Abstract
Diverticular disease is not uncommon problem in clinical practice, and sometimes causes serious complication such as lower gastrointestinal bleeding or perforation. The severity of both diverticular complications can differ. Most of diverticular bleeding stops spontaneously, but if a massive bleeding is presented, quick and optimal decision to find the focus of the bleeding and to treat the bleeding lesion using colonoscopy, abdominal CT, and angiography should be required. It is important to understand which procedure is indicated and what measures should be considered before moving to the next diagnostic or therapeutic procedures in individual cases. Diverticular perforation usually accompanies abscesses or peritonitis. Based on the CT classification of diverticular perforation, antibiotics and percutaneous drainage can be one of the choices for treatment in abscesses without general peritonitis. In case of free wall perforation and generalized peritonitis, it has been thought that Hartmann's procedure should be carried out. However, recently several reports demonstrated that the less invasive procedure such as laparoscopic lavage can be the treatment option for purulent peritonitis without fecal contamination. Clinical diagnosis and treatment of diverticular bleeding and perforation based on current literature are discussed in this review.
Keywords
Colon; Diverticulum; Hemorrhage; Perforation;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Wong SK, Ho YH, Leong AP, Seow-Choen F. Clinical behavior of complicated right-sided and left-sided diverticulosis. Dis Colon Rectum 1997;40:344-348.   DOI   ScienceOn
2 Lewis M; NDSG. Bleeding colonic diverticula. J Clin Gastroenterol 2008;42:1156-1158.   DOI   ScienceOn
3 Hall J, Hammerich K, Roberts P. New paradigms in the management of diverticular disease. Curr Probl Surg 2010; 47:680-735.   DOI   ScienceOn
4 Jensen DM, Machicado GA, Jutabha R, Kovacs TO. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Engl J Med 2000;342:78-82.   DOI   ScienceOn
5 Davila RE, Rajan E, Adler DG, et al. ASGE guideline: the role of endoscopy in the patient with lower-GI bleeding. Gastrointest Endosc 2005;62:656-660.   DOI   ScienceOn
6 Smith R, Copely DJ, Bolen FH. 99mTc RBC scintigraphy: correlation of gastrointestinal bleeding rates with scintigraphic findings. AJR Am J Roentgenol 1987;148:869-874.   DOI   ScienceOn
7 DeBarros J, Rosas L, Cohen J, Vignati P, Sardella W, Hallisey M. The changing paradigm for the treatment of colonic hemorrhage: superselective angiographic embolization. Dis Colon Rectum 2002;45:802-808.   DOI   ScienceOn
8 Gordon RL, Ahl KL, Kerlan RK, et al. Selective arterial embolization for the control of lower gastrointestinal bleeding. Am J Surg 1997;174:24-28.   DOI   ScienceOn
9 Parkes BM, Obeid FN, Sorensen VJ, Horst HM, Fath JJ. The management of massive lower gastrointestinal bleeding. Am Surg 1993;59:676-678.
10 Jacobs DO. Clinical practice: diverticulitis. N Engl J Med 2007;357:2057-2066.   DOI   ScienceOn
11 Baker ME. Imaging and interventional techniques in acute left-sided diverticulitis. J Gastrointest Surg 2008;12:1314- 1317.   DOI
12 Kaiser AM, Jiang JK, Lake JP, et al. The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol 2005;100:910-917.   DOI   ScienceOn
13 Lahat A, Yanai H, Sakhnini E, Menachem Y, Bar-Meir S. Role of colonoscopy in patients with persistent acute diverticulitis. World J Gastroenterol 2008;14:2763-2766.   DOI   ScienceOn
14 Golfieri R, Cappelli A. Computed tomography-guided percutaneous abscess drainage in coloproctology: review of the literature. Tech Coloproctol 2007;11:197-208.   DOI
15 Rafferty J, Shellito P, Hyman NH, Buie WD; Standards Committee of American Society of Colon and Rectal Surgeons. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum 2006;49:939-944.   DOI   ScienceOn
16 Psarras K, Symeonidis NG, Pavlidis ET, et al. Current management of diverticular disease complications. Tech Coloproctol 2011;15(Suppl 1):S9-12.   DOI   ScienceOn
17 Myers E, Hurley M, O'Sullivan GC, Kavanagh D, Wilson I, Winter DC. Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis. Br J Surg 2008; 95:97-101.
18 Alamili M, Gogenur I, Rosenberg J. Acute complicated diverticulitis managed by laparoscopic lavage. Dis Colon Rectum 2009;52:1345-1349.   DOI   ScienceOn
19 Kumar RR, Kim JT, Haukoos JS, et al. Factors affecting the successful management of intra-abdominal abscesses with antibiotics and the need for percutaneous drainage. Dis Colon Rectum 2006;49:183-189.   DOI   ScienceOn
20 Siewert B, Tye G, Kruskal J, et al. Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. AJR Am J Roentgenol 2006;186:680-686.   DOI   ScienceOn
21 Ambrosetti P, Chautems R, Soravia C, Peiris-Waser N, Terrier F. Long-term outcome of mesocolic and pelvic diverticular abscesses of the left colon: a prospective study of 73 cases. Dis Colon Rectum 2005;48:787-791.   DOI   ScienceOn
22 Abbas S. Resection and primary anastomosis in acute complicated diverticulitis, a systematic review of the literature. Int J Colorectal Dis 2007;22:351-357.   DOI
23 O'Sullivan GC, Murphy D, O'Brien MG, Ireland A. Laparoscopic management of generalized peritonitis due to perforated colonic diverticula. Am J Surg 1996;171:432-434.   DOI   ScienceOn
24 Stollman N, Raskin JB. Diverticular disease of the colon. Lancet 2004;363:631-639.   DOI   ScienceOn
25 Soumian S, Thomas S, Mohan PP, Khan N, Khan Z, Raju T. Management of Hinchey II diverticulitis. World J Gastroenterol 2008;14:7163-7169.   DOI
26 Gayer C, Chino A, Lucas C, et al. Acute lower gastrointestinal bleeding in 1,112 patients admitted to an urban emergency medical center. Surgery 2009;146:600-606.   DOI   ScienceOn