Pathogenesis of Bleeding Colonic Diverticulosis

Meyers, Morton A.; Alonso, Daniel R.; Gray, George F.; Baer, Jeanne W.

doi:10.1016/s0016-5085(76)80545-8

Cited by 193 publications

(65 citation statements)

References 8 publications

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“…6 When angiography is used for diagnosis, the source is more likely to be from the right colon. [51][52][53] This inconsistency may reflect differences in diagnostic sensitivity between the two tests, with angiography being less sensitive than colonoscopy for the diagnosis of less-severe diverticular bleeding. 103 At colonoscopy, angiodysplasia are recognized by their characteristic appearance as red, fern-like flat lesions consisting of ectatic blood vessels that appear to radiate from a central feeding vessel; they may have a diameter of 2-10 mm.…”

Section: Diagnostic Colonoscopymentioning

confidence: 99%

Review article: the management of lower gastrointestinal bleeding

Farrell

2005

Aliment Pharmacol Ther

193

129

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SUMMARYSeveral recent advances have been made in the evaluation and management of acute lower gastrointestinal bleeding. This review focuses on the management of lower gastrointestinal bleeding, especially acute severe bleeding. The aim of the study was to critically review the published literature on important management issues in lower gastrointestinal bleeding, including haemodynamic resuscitation, diagnostic evaluation, and endoscopic, radiologic, and surgical therapy, and to develop an algorithm for the management of lower gastrointestinal bleeding, based on this literature review.Publications pertaining to lower gastrointestinal bleeding were identified by searches of the MEDLINE database for the years 1966 to December 2004. Clinical trials and review articles were specifically identified, and their reference citation lists were searched for additional publications not identified in the database searches. Clinical trials and current clinical recommendations were assessed by using commonly applied criteria. Specific recommendations are made based on the evidence reviewed.Approximately, 200 original and review articles were reviewed and graded. There is a paucity of high-quality evidence to guide the management of lower gastrointestinal bleeding, and current endoscopic, radiologic, and surgical practices appear to reflect local expertise and availability of services. Endoscopic literature supports the role of urgent colonoscopy and therapy where possible. Radiology literature supports the role of angiography, especially after a positive bleeding scan has been obtained. Limited surgical data support the role of segmental resection in the management of persistent lower gastrointestinal bleeding after localization by either colonoscopy or angiography.There is limited high-quality research in the area of lower gastrointestinal bleeding. Recent advances have improved the endoscopic, radiologic and surgical management of this problem. However, treatment decisions are still often based on local expertise and preference. With increased access to urgent therapeutic endoscopy for the management of acute upper gastrointestinal bleeding, diagnostic and therapeutic colonoscopy can be expected to play an increasing role in the management of acute lower gastrointestinal bleeding. INTRODUCTIONLower gastrointestinal bleeding is one-fifth to one-third as common as upper gastrointestinal bleeding and generally has a less severe course. The annual incidence rate of lower gastrointestinal bleeding in the US ranges from 20.5 to 27 cases per 100 000 adult population at risk (0.03%). In contrast, the annual incidence rate for upper gastrointestinal bleeding is reported to range from 100 to 200 cases per 100 000. As in upper gastrointestinal bleeding, lower gastrointestinal bleeding stops spontaneously in most cases (80-85%). 1The mean age of patients with lower gastrointestinal bleeding ranges from 63 to 77 years, with a reported mortality rate of 2-4% (Table 1). [2][3][4][5][6][7] The incidence rate of lower gastrointestinal bleed...

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Section: Diagnostic Colonoscopymentioning

confidence: 99%

Review article: the management of lower gastrointestinal bleeding

Farrell

2005

Aliment Pharmacol Ther

193

129

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“…Microscopically the structural changes in the wall of the blood vessel are noticed as thickening of the intima and thinning of the media, what may explain the grounds for bleeding. It should be emphasized that, contrary to widely accepted opinion, the inflammation is not associated with the cause of bleeding, as proved by several studies 19 .…”

Section: Possible Further Investigations Of Lgib Are As Followsmentioning

confidence: 73%

“…Mayers and al. 19 have defined it as the one occurring from the ruptured v. recta in the diverticulum. Microscopically the structural changes in the wall of the blood vessel are noticed as thickening of the intima and thinning of the media, what may explain the grounds for bleeding.…”

Section: Possible Further Investigations Of Lgib Are As Followsmentioning

confidence: 99%

Diagnostic and therapeutic approaches to bleeding from lower parts of the digestive system

Antić¹,

Dimitrijević²,

Marković³

et al. 2008

ACTA CHIR IUG

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Bleeding from the gastrointestinal tract represents relatively common diagnostic and therapeutic challenge in clinical work of gastroenterologists and surgeons. Bleeding from the lower GI (LGIB) is mostly caused by pathologic conditions of the colon, although the source of bleeding cannot always be exactly localized, thus rendering optimal and prompt therapy difficult. During two year period, at IlI department of the First Surgical Clinic in Belgrade, we performed 424 colonoscopies for LGIB. According to our results the exact diagnosis was established in about 76% (324 patients) showing a great similarity with the results of other published studies (varying between 74% and 89%). The most common causes of bleeding were diverticulosis (37.11%), polyposis (10.3%) and colorectal cancer (46.14%). Besides that we have mentioned some specific facts involving the diagnosis and treatment of LGIB with an accent on some rare conditions, like angiodysplasia. Review of the diagnostic procedures and treatment modalities of the LGIB is useful for everyone who meets with this type of pathology in clinical practice. The diagnostic approach and the surgical treatment of these patients may represent a great problem, since the planning of the operative procedure can be very difficult and with uncertain result. Based on the literary data and our experience we have tried to set the algorithm of the diagnostics and treatment of the LGIB.

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“…At first, this patient had been suspected of a complicated development of a diverticulosis. However, the luminal, expansive ulcerations with a red marginal seam as well as the accompanying inflammatory changes in the terminal ileum, do not match a classical diverticle complication (26). The dissemination pattern of the changes in the mucous membranes and the transmural inflammation type, could indicate Morbus Crohn; however, no further histological characteristic features of Crohn's disease could be located.…”

Section: Discussionmentioning

confidence: 93%