Right-sided colonic diverticular disease as a source of lower gastrointestinal bleeding

Right-sided colonic diverticular disease is a distinct disease entity uncom mon in the West. Occasionally, the condition may be complicated by hemorrha ge and present as lower gastrointestinal bleeding. We report a series of 25 cases of bleeding right colon diverticulosis and discuss its presentation and management. Patients were selected from the colonoscopic reports of all 190 patients presented with suspected acute lower gastrointestinal bleedin g in National University Hospital, Singapore, from 1988 to 1994. Fifty-seve n patients (30%) had bleeding diverticulosis in which 25 patients (44%) suf fered from right-sided disease. Sixty-four per cent of patients had a histo ry of hypertension. Patients presented with either fresh blood in stools or melena. Fifteen patients (60%) required blood transfusion (median, 2 units ). Colonoscopy showed blood clots in the right colon in 15 cases (60%) and active bleeding from the right colon diverticula in 3 patients (12%). The b leeding stopped spontaneously in 16 patients (64%). The other 9 patients re quired surgery because of continuous or recurrent bleeding. All had a right hemicolectomy performed. The hospital stay was 13 days in this group, comp ared with 5 days for those undergoing conservative treatment (P = 0.0004). There were no deaths. No patients had further bleeding episodes during a me dian 7-month follow-up.