Diverticular disease-associated hemorrhage in the elderly

Lower gastrointestinal bleeding is frequent in the elderly secondary to div erticular disease and occurs in about 10-30%. It is the most frequent cause of lower gastrointestinal hemorrhage (about 40% of cases) followed by angi odysplasia (up to 20% of cases). The incidence of both diseases increase wi th age, but the patient's general condition and state of health decrease. O ften cardiovascular morbidity coexists, resulting in an eventual risk of is chemic consequences. The intensity of bleeding varies from massive to occul t. In diverticular disease, hemorrhage is caused by rupture or erosion of t he vasa recti stretched by diverticula. Classically inflammation is absent. Although most diverticula (>90%) are located in the sigmoid colon, bleedin g originates more frequently from the right (>50%) than the left colon. The preferred diagnostic tool following resuscitation is colonoscopy with an a bility to locate the site of bleeding in up to 90% of cases. Additionally, injections and thermocoagulation are available to control bleeding endoscop ically with a success rate of about 27%. Angiography is considerably variab le concerning positive results (13.6-86%), has a complication rate of about 10% and is expensive. Hence, it is a second-line diagnostic method. Divert icular hemorrhage will cease spontaneously in about 90% of cases. Therefore , conservative treatment is preferred. Patients with persistent, massive or recurrent bleeding despite active conservative measures require surgical t reatment, If surgical intervention is necessary, the site of hemorrhage mus t be sought to allow segmental resection, However, if the source of blood l oss cannot be located, a subtotal colectomy is justified.