Right-Sided Colonic Diverticula as a Cause of Acute Rectal Hemorrhage

Casarella, William J.; Kanter, Ira E.; Seaman, William B.

doi:10.1056/nejm197203022860902

Cited by 122 publications

(21 citation statements)

References 17 publications

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“…Colonic diverticular bleeding occurs on the right side of the colon in 50-90% of patients with diverticula (Table 1) [42,46,47]. This reveals a marked increase in the risk of bleeding for the right-sided diverticula, as in Western countries only 25% of diverticula are located on the right side of the colon [48].…”

Section: Diverticular Bleedingmentioning

confidence: 99%

The Burden of Diverticular Disease and Its Complications: West versus East

Imaeda¹,

Hibi²

2018

Inflamm Intest Dis

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Background: Colonic diverticulosis is prevalent and increasing not only in Western but also in Asian countries. Diverticulosis can be complicated by diverticulitis and diverticular bleeding. Diverticular disease is a burdensome digestive disease, because it is a major cause of hospital admissions and is associated with significant health-care costs. Summary: The incidence of diverticulosis increases with age. Most cases of diverticulosis in Western countries involve the left side of the colon, while diverticulosis is predominantly present on the right side of the colon in Asian countries. The incidence of diverticulitis also increases with age. Diverticulitis is predominantly located on the left side of the colon in Western countries, while it is predominantly located on the right side of the colon in Asian countries. The overall complication rate is higher in left-sided than in right-sided diverticulitis. The incidence of diverticular bleeding also increases with age. The right colon is the source of diverticular bleeding in more than 50% of patients in Western countries. In Asian countries, age greater than 70 years and both-sided diverticulosis increase the bleeding risk. Key Messages: In Western countries, diverticulosis and diverticulitis are predominantly located on the left side of the colon, whereas they are predominantly present on the right side of the colon in Asian countries. Diverticular bleeding is predominantly located on the right side in Western countries, and both-sided diverticulosis increases the risk of bleeding in Asian countries. Diverticular disease with complications requires admission and operation; moreover, it recurs frequently. Therefore, diverticular disease is associated with a significant economic burden in terms of health-care costs and resource utilization.

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Section: Diverticular Bleedingmentioning

confidence: 99%

The Burden of Diverticular Disease and Its Complications: West versus East

Imaeda¹,

Hibi²

2018

Inflamm Intest Dis

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“…Severe hemorrhage can arise in 3-5% of patients with diverticulosis [63,64] . Despite the fact that most diverticula are in the left colon in subjects from developed Western countries, the site of bleeding may more often be located in the proximal colon [63,[65][66][67][68] . Microangiography on resected specimens from patients with bleeding diverticula shows intimal thickening and medial thinning of the vasa recta as it courses over the dome of the diverticulum [65] .…”

Section: Hemorrhagementioning

confidence: 99%

Diverticular Disease in the Elderly

Comparato

Pilotto

Franzè

et al. 2007

Dig Dis

125

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There are few diseases whose incidence varies as greatly worldwide as that of diverticulosis. Its prevalence is largely age-dependent: the disease is uncommon in those under the age of 40, the prevalence of which is estimated at approximately 5%; this increases to 65% in those ≧65 years of age. Of patients with diverticula, 80–85% remain asymptomatic, while, for unknown reasons, only three-fourths of the remaining 15–20% of patients develop symptomatic diverticular disease. Traditional concepts regarding the causes of colonic diverticula include alterations in colonic wall resistance, disordered colonic motility and dietary fiber deficiency. Currently, inflammation has been proposed to play a role in diverticular disease. Goals of therapy in diverticular disease should include improvement of symptoms and prevention of recurrent attacks in symptomatic, uncomplicated diverticular disease, and prevention of the complications of disease such as diverticulitis. Diverticulitis is the most usual clinical complication of diverticular disease, affecting 10–25% of patients with diverticula. Most patients admitted with acute diverticulitis respond to conservative treatment, but 15–30% require surgery. Predictive factors for severe diverticulitis are sex, obesity, immunodeficiency and old age. Surgery for acute complications of diverticular disease of the sigmoid colon carries significant rates of morbidity and mortality, the latter of which occurs predominantly in cases of severe comorbidity. Postoperative mortality and morbidity are to a large extent driven by patient-related factors.

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“…These changes may result in segmental weakness of the artery, predisposing to rupture into the lumen [7]. Unlike diverticulitis, which occurs primarily in the left colon, the right colon is the source of colonic diverticular bleeding in 50-90% of patients [2,[7][8][9]. This reflects a marked increase in the propensity for right-sided diverticula to bleed, since, in Western countries, only 25% of diverticula are right-sided [10].…”

Section: Introductionmentioning

confidence: 99%

Management of Diverticular Hemorrhage: Catching That Culprit Diverticulum Red-Handed!

2018

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Background/Summary: Acute colonic diverticular hemorrhage (CDH) represents a significant challenge for gastroenterologists. There are some clinical problems in the diagnosis, treatment, and prevention of CDH. CDH is the most common cause of overt lower gastrointestinal bleeding in adults in Eastern and Western countries. Moreover, CDH imposes significant economic and clinical burdens on the health care system. Colonoscopy is recommended as a useful diagnostic tool for CDH after bowel preparation. Colonoscopy can be used to identify the culprit diverticulum and to provide endoscopic therapy. In most cases, however, the bleeding stops spontaneously. For this reason, it is still controversial whether urgent colonoscopy or elective colonoscopy is “preferable.” Key Messages: This review aims to highlight the various clinical problems (purge, timing of colonoscopy, CT angiography, and endoscopy) encountered in the attempt to identify and treat the culprit diverticulum red-handed.

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Right-Sided Colonic Diverticula as a Cause of Acute Rectal Hemorrhage

Cited by 122 publications

References 17 publications

The Burden of Diverticular Disease and Its Complications: West versus East

The Burden of Diverticular Disease and Its Complications: West versus East

Diverticular Disease in the Elderly

Management of Diverticular Hemorrhage: Catching That Culprit Diverticulum Red-Handed!

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