The prevalence of diverticular disease increases with age, and bleeding from colonic
diverticula is the most common cause of acute lower gastrointestinal bleeding, accounting
for approximately 40 % of cases. The incidence of bleeding ranges from 5 % to 50 %.
Because bleeding frequently stops spontaneously, the diagnosis is often presumptive
and based on the exclusion of other sources of bleeding [1].
A 56-year-old man presented with painless hematochezia. He had no medical history
of a bleeding tendency. Urgent colonoscopy demonstrated a large amount of fresh blood
in the ascending colon, precluding adequate inspection of the mucosa. After extensive
washing and instillation of water in the general area of the site, however, the bleeding
diverticulum was clearly observed (Figure [1]). We found that water instillation during the examination effectively enabled direct
observation of the bleeding. The bleeding stopped after hemoclips were applied to
the margin of the diverticulum (Figure [2]). The patient remains well 12 months after the procedure.
Figure 1 Bleeding from the diverticulum was clearly identified (arrow) using the water-instillation
method.
Figure 2 The bleeding stopped after two attempts at clip application.
Several endoscopic treatment modalities can be used to achieve hemostasis when a source
of lower gastrointestinal bleeding is identified. Thermal-contact modalities, including
a heat probe and bipolar or multipolar coagulation, and epinephrine injection can
be used independently or together [2], but endoscopic placement of metallic clips might serve as a safe and effective
treatment for diverticular hemorrhage [3]. The management of the patient presented here represents a case where effective
detection and treatment of a bleeding colonic diverticulum was achieved.
Endoscopy_UCTN_Code_CCL_1AD_2AF
