Bowel

Diverticular Bleeding

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Diverticular Bleeding, Diverticular Hemorrhage

  • See Also
  1. Diverticulosis
  2. Diverticulitis
  3. Lower Gastrointestinal Bleeding
  • Epidemiology
  1. Most common cause of Lower Gastrointestinal Bleeding (23% of cases)
  2. Severe, life threatening Lower Gastrointestinal Bleeding occur in 3 to 5% of patients with Diverticulosis
  3. Most cases occur in age over 50 years
  • Risk Factors
  1. Age over 65 years
  2. Increased risk with NSAIDs or Aspirin
  • Pathophysiology
  1. Diverticula can occur anywhere in the Large Bowel
  2. Most common site for Diverticular Bleeding is at on the right side, at the ascending colon
    1. Right sided Diverticula have a narrow base and larger dome and thinner wall, with higher risk of bleeding
  3. Bleeding occurs as penetrating vessels in the bowel wall erode from chronic microtrauma
    1. Acute inflammation is typically absent in Diverticular Bleeding (contrast with acute Diverticulitis)
  • Symptoms
  1. Painless Rectal Hemorrhage
  2. Irritate symptoms due to acute bleeding may occur
    1. Mild abdominal cramping
    2. Stool urgency
  • Signs
  1. Red to Maroon Stool which may contain intermixed blood clot
  • Differential Diagnosis
  1. See Lower Gastrointestinal Bleeding
  2. Signs of Hemorrhagic Shock may be present
    1. Tachycardia
    2. Hypotension
    3. Orthostatic Hypotension
  • Course
  1. Bleeding spontaneously ceases in 75%, recurs in 22 to 38%
  2. Recurrence is 9% at one year and 25% at 4 years
  • Management
  1. See Lower Gastrointestinal Bleeding for bleeding site evaluation and management
  2. A small percentage of Diverticular bleeds require surgical intervention
  • Prognosis
  • Comorbidities that increase complication risk
  1. Hypertension
  2. Diabetes Mellitus
  3. Chronic Obstructive Pulmonary Disease (COPD)
  4. Chronic Kidney Disease
  5. Coronary Artery Disease
  • Prevention
  1. Avoid Aspirin and NSAIDs
  2. Increase Dietary Fiber
  3. Weight loss in Obesity with goal Body Mass Index <30 kg/m2
  • References
  1. Kleinmann (2023) Crit Dis Emerg Med 37(2): 22-9
  2. Wilkins (2009) Am Fam Physician 80(9): 977-83 [PubMed]