Severe hematochezia associated with colonoscopic diverticulitis

Diverticular bleeding is a common cause of massive, painless hematochezia. The clinical dictum states that diverticulitis is not associated with acute, life-threatening, lower GI bleeding. However, in our practice we have noted an association between diverticulitis and massive lower GI bleeding; therefore we retrospectively reviewed the medical records of 7 consecutive, private patients admitted to the hospital over a 10 month period with an admitting diagnosis of severe hematochezia and a discharge diagnosis of diverticulitis. Results: Patient Age, Sex Hct drop (low) Clinical presentation suggestive of diverticulitis 1 87, M 5 (37%) none 2 72, M 14 (25) none 3 82, F 3 (31) none 4 56, M 9 (30) none 5 79, F 11 (24) lower abd pain, LLQ tender 6 84, F 9 (24) LLQ pain, leukocytosis 7 83, F - (20) LLQ pain, tenderness Patient 1, 2, 3, and 4 on colonoscopy had a single ruptured and inflamed diverticulum. Patient 5 demonstrated mucosal edema, erythema, petechiae, and a mucopurulent discharge from a perforated diverticulum. Patient 6 had evidence of an intramural abscess secondary to diverticulitis. Patient 7 had a frozen sigmoid on a "second-look" colonoscopy due to diverticulitis and stricture formation. Patients 5, 6, and 7 required packed red blood cell transfusions (1, 2 and 4 units, respectively) for stabilization. Conclusion: A subgroup of patients with acute, life-threatening, lower GI bleeding were found on colonoscopy to have diverticulitis. We suggest that patients who present with severe diverticular bleeding that is associated with LLQ pain and tenderness, fever, leukocytosis or recurrent bleeding over several days should have a colonoscopy performed after the bleeding has stopped, and if diverticulitis is present, antibiotics should be prescribed. If the bleeding is secondary to diverticulitis this may reduce the rebleeding rate, the transfusion requirements, the need for surgery, and ultimately may shorten hospitalization.