Diverticular haemorrhage

Haemorrhage as a result of a diverticulum can be life-threatening. The differential diagnosis of intra-abdominal bleeding is:

• severe haemorrhoidal bleeding into the colon
• angiodysplasia on the right side of the colon
• polyps and cancer

Investigation is undertaken with:

• colonoscopy: done peroperatively after an on-table colonic washout
• angiography: may show a vascular abnormality or pooling of contrast in the intestine
• bleeding scans: achieved by scanning after prior adminstration of radio-labelled red cells

The indication for surgical intervention is unclear, but the loss of four or more units has been suggested as a threshold. If the bleeding site is not known, the choice of operation is total colectomy with an ileorectal anastomosis or ileostomy. If the bleeding point has been visualised, a segmental resection should be undertaken.