BLEEDING COLONIC DIVERTICULA - A REAPPRAISAL OF NATURAL-HISTORY AND MANAGEMENT

Objective The study was undertaken to correct or reaffirm current reco mmendations based on old observations of doubtful validity because of their lack of routine colonoscopy, scintigraphy, or angiography. Metho d Patterns of bleeding were derived from transfusion records of 78 pat ients admitted 106 times for lower gastrointestinal bleeding with no d etectable cause other than colon diverticula. Result Bleeding slopped spontaneously in 82 of 108 episodes and in 66 of 67 patients requiring less than four units of transfusion on any day. When four or more uni ts were required in a day, 25 of 42 patients required emergency surger y. When a bleeding site was identified and removed, only 1 of 25 patie nts bled again from another diverticulum. After discharge without surg ery, 28 of 73 began to bled again. After ''blind'' colectomy and ileop roctostomy, four of seven patients developed leaks or abscesses, and t wo died. Conclusions Bleeding stopped spontaneously in 75% of episodes and in 99% of patients requiring less than four units of transfusion per day. Bleeding continued in 25% of episodes and in most patients wh o required four or more units per day. Bleeding sites of those patient s who continued to bleed were shown by scintigraphy or angiography. Wh en a bleeding diverticulum is removed, rebleeding is rare. ''Blind'' r esection is unsafe.