Management of colonic diverticular bleeding and bleeding colitis

Abstract

Colonic diverticular bleeding and colitis account for the majority of cases of lower gastrointestinal bleeding, with diverticular bleeding being by far the most common etiology. In contrast to diverticulitis, colonic diverticular bleeding most commonly originates in the ascending colon. Management of diverticular bleeding should start with adequate volume resuscitation, followed by colonoscopic localization and control of the bleeding site. Selective angiography may be employed for those who cannot undergo colonoscopy or underwent unsuccessful colonoscopic evaluation or treatment. Surgery is reserved for intractable diverticular bleeding. Bleeding from colitis is usually intermittent and self-limited. In hemodynamically stable patients with colitis bleeding, treatment should be aimed at control of the source of inflammation. If hemodynamic stability is compromised or if bleeding is severe, angiography and/or emergent resection should be considered.