haemorrhage (diverticular)
Last reviewed 01/2018
Haemorrhage as a result of a diverticulum can be life-threatening. The differential diagnosis of intra-abdominal bleeding is:
- severe haemorrhoidal bleeding into the colon
- angiodysplasia on the right side of the colon
- polyps and cancer
Investigation is undertaken with:
- colonoscopy: done peroperatively after an on-table colonic washout
- angiography: may show a vascular abnormality or pooling of contrast in the intestine
- bleeding scans: achieved by scanning after prior adminstration of radio-labelled red cells
The indication for surgical intervention is unclear, but the loss of four or more units has been suggested as a threshold. If the bleeding site is not known, the choice of operation is total colectomy with an ileorectal anastomosis or ileostomy. If the bleeding point has been visualised, a segmental resection should be undertaken.