II. Epidemiology
- Most common cause of Lower Gastrointestinal Bleeding (23% of cases)
- Severe, life threatening Lower Gastrointestinal Bleeding occur in 3 to 5% of patients with Diverticulosis
- Most cases occur in age over 50 years
IV. Pathophysiology
- Diverticula can occur anywhere in the Large Bowel
- Most common site for Diverticular Bleeding is at on the right side, at the ascending colon
- Right sided Diverticula have a narrow base and larger dome and thinner wall, with higher risk of bleeding
- Bleeding occurs as penetrating vessels in the bowel wall erode from chronic microtrauma
- Acute inflammation is typically absent in Diverticular Bleeding (contrast with acute Diverticulitis)
V. Symptoms
- Painless Rectal Hemorrhage
- Irritate symptoms due to acute bleeding may occur
- Mild abdominal cramping
- Stool urgency
VI. Signs
- Red to Maroon Stool which may contain intermixed blood clot
VII. Differential Diagnosis
- See Lower Gastrointestinal Bleeding
- Signs of Hemorrhagic Shock may be present
VIII. Course
- Bleeding spontaneously ceases in 75%, recurs in 22 to 38%
- Recurrence is 9% at one year and 25% at 4 years
IX. Management
- See Lower Gastrointestinal Bleeding for bleeding site evaluation and management
- A small percentage of Diverticular bleeds require surgical intervention
X. Prognosis: Comorbidities that increase complication risk
XI. Prevention
- Avoid Aspirin and NSAIDs
- Increase Dietary Fiber
- Weight loss in Obesity with goal Body Mass Index <30 kg/m2
XII. References
- Kleinmann (2023) Crit Dis Emerg Med 37(2): 22-9
- Wilkins (2009) Am Fam Physician 80(9): 977-83 [PubMed]
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Related Studies
| Concepts | Disease or Syndrome (T047) |
| ICD9 | 562.12 |
| English | Diverticulosis of colon with hemorrhage, Dvrtclo colon w hmrhg, Diverticulosis of colon with haemorrhage |
| Dutch | diverticulose van het colon met bloeding, diverticulose van colon met bloeding |
| French | Diverticulose du côlon avec hémorragie |
| German | Divertikulose des Kolons mit Blutung |
| Italian | Diverticolosi del colon con emorragia |
| Portuguese | Diverticulose do cólon com hemorragia |
| Spanish | Diverticulosis de colon con hemorragia |
| Japanese | 出血性結腸憩室, ｼｭｯｹﾂｾｲｹｯﾁｮｳｹｲｼﾂ |
| Czech | Divertikulóza tračníku s krvácením |
| Hungarian | Colon diverticulosisa vérzéssel |
