Colonic Diverticular Bleeding: A Case Report and Review of the Literature
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 18, Issue 4
Abstract
In Japan, colonic diverticular bleeding has been increasing due to the prevalence of colonic diverticula has increased [1,2]. However, it is uncommon to treat patients with colonic diverticular bleeding in China. Colonic diverticular bleeding is an acute illness, they often recur and necessitate colectomy when endoscopic treatment failed, which makes this disease of great importance in clinical settings. The management of diverticular bleeding differs between China and Western countries. Computed tomography (CT) tends to be the first option at Chinese hospitals, so urgent CT may be selected as the first diagnostic procedure for suspected diverticular infection or bleeding. Novel treatment methods such as endoscopic clipping or band ligation have been introduced as hemostatic techniques for colonic diverticular bleeding [3,4]. Therefore, endoscopic clipping or band ligation may be preferred as the first endoscopic procedure for diverticular bleeding in western countries. Here, we report a case of colonic diverticular bleeding caused by diverticular infection in a 56-year-old male who finally underwent endoscopic treatment after administration of antibiotics could not relieve his symptoms.A 56-year-old man, presented with pain in his right side along with hematochezia seven times in half day, he was admitted at Emergency Department. The result of vital signs was normal. The physical examination showed tenderness and rebound tenderness in the right abdomen. Digital rectal examination (DRE) result was positive. Blood test revealed white blood cell (WBC): 6.53*10^9/L, percentage of neutrophils: 54.2%, Hemoglobin (HB): 145g/L, platelet (PLT): 303*10^9/L. An urgent abdominal CT scan revealed multiple diverticulum with suspicious infection were found at the ileocecal junction. Patient reported the medical history of hemorrhoids, atrial fibrillation, colon polyps and diverticulum. He denied the history of hypertension, diabetes and HIV infection. The first day of hospitalization, blood test showed white blood cell (WBC): 6.46*10^9/L, neutrophils: 60.6%, Hemoglobin (HB): 159g/L, platelet (PLT): 311*10^9/L, hematocrit (HCT): 46.9%. The result of fecal occult blood test (FOBT) was positive. Doctor prescribed fasting and given intravenous nutrition support. Meanwhile, use proton pump inhibitors (PPIs) and antibiotics as part of the treatment. Gradually, the symptom of abdominal pain relieved and no hematochezia existed. On the second day of hospitalization, the condition of this patient was stable, better than the first day and no hematochezia. He began to fluid diet and continued to the previous therapy. However, on the third day at hospital, massive hematochezia occurred again together with right lower abdominal tenderness. The emergency colonoscopy showed bright red blood and multiple diverticula in the ileocecal junction. After profuse water irrigation, active arterial bleeding from a diverticulum was identified near the vermiform appendix. The bleeding was treated by a combination of adrenaline injection followed by hemostatic clips. Hemostasis was rapidly achieved and no rebleeding or hematochezia had occurred. The patient recovered well and was discharged 5 days after the surgery. No discomfort has been reported by a 30-day follow-up visit (Figure 1).
Authors and Affiliations
Jian Li, Songhua Bei, Xiaohong Zhang, Li Feng
Keywords
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- EP ID EP621938
- DOI 10.26717/BJSTR.2019.18.003189
- Views 160
- Downloads 0
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