Authors
Levchuk A.L.1, Abdullaev A.E.2
1 Pirogov National Medical and Surgical Center, Moscow
2 Vladimir City Emergency Hospital, Vladimir
Abstract
A review of the literature on the problem of diagnosis, conservative and operative hemostasis in patients with diverticular colonic bleeding is presented. Treatment of bleeding from the lower gastrointestinal tract remains an important task of urgent surgery. Currently, there are no clear indications regarding the most appropriate treatment methods, there are no effective ways to prevent diverticular bleeding. The treatment and diagnosis of DC has evolved with the advent of interventional endoscopy and angiography. This made it possible to limit the indications for emergency surgery without clearly identifying the source of bleeding. The development of effective methods of hemostasis in DC is an important task. This section of urgent surgery is still insufficiently covered, there are no clear indications for various methods of diagnosis and treatment of diverticular colonic bleeding, which require further study.
Keywords: diverticular colon disease, intestinal bleeding, methods of conservative and surgical hemostasis.
References
1. Temirbulatov VM, et al. Diverticular colon disease. Moscow: Medical Book, 2000. (In Russ.)
2. Clinical recommendations for the diagnosis and treatment of adult patients with diverticular colon disease. 2013. (In Russ.)
3. Shelygin YA, Achkasov SI, Moskalev AI. Laparoscopic access during planned surgical treatment of diverticular disease. Coloproctology. 2014; 4: 5-13. (In Russ.)
4. Imaeda H, Hibi T. The burden of diverticular disease and its complications: West versus East. Inflamm Intest Dis. 2018; 3: 61-68. doi:10.1159/000492178.
5. Oguri N, Ikeya T, Kobayashi D, et al. Effectiveness of risk scoring systems in predicting endoscopic treatment in colonic diverticular bleeding. J Gastroenterol Hepatol. 2020; 35: 815-820. doi:10.1111/jgh.14901.
6. Oakland K, Guy R, Uberoi R, et al. Acute lower GI bleeding in the UK: patient characteristics, interventions and outcomes in the first nationwide audit. Gut. 2018; 67: 654-662. doi:10.1136/gutjnl-2016-313428.
7. Nagata N, Niikura R, Aoki T, et al. Increase in colonic diverticulosis and diverticular hemorrhaging in an aging society: lessons from a 9-year colonoscopic study of 28,192 patients in Japan. Int J Colorectal Dis. 2021; 29: 379-385. doi: 10.1007/s00384-013-1808-4.
8. Peery AF, Dellon ES, Lund J, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2018; 143: 1179-1187. doi: 10.1053/j.gastro.2012.08.002.
9. Thad W., Christine B., Andrew N. P., Robert R. Schade, Diverticular Bleeding. American Family Physician. 2019; 9: 80.
10. Nagata N, Ishii N, Manabe N, et al. Guidelines for colonic diverticular bleeding and colonic diverticulitis: Japan Gastroenterological Association. Digestion. 2019; 99: 26 doi: 10.1159/000495282.
11. Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am. J. Gastroenterol. 2016; 111: 459-474 doi: 10.1038/ajg.2016.41.
12. Gobinet-Suguro М, et al Treatment strategies for reducing early and late recurrence of colonic diverticular bleeding based on stigmata of recent hemorrhage: a large multicenter study. Gastrointestinal endoscopy. 2022; 95; 6. doi: 10.1016/j.gie.2021.12.023.
13. Nakatsu S, Yasuda H, Maehata T, et al. Urgent computed tomography for determining the optimal timing of colonoscopy in patients with acute lower gastrointestinal bleeding. Intern Med. 2015; 54: 553-558. doi: 10.2169/ internalmedicine.54.2829.
14. McGuire HH Jr. Bleeding colonic diverticula. A reappraisal of natural history and management. Ann Surg. 2020; 2: 653-656. doi: 10.1097/ 00000658-199411000-00008.
15. Sugiyama T, Hirata Y, Kojima Y, et al. Efficacy of contrast-enhanced computed tomography for the treatment strategy of colonic diverticular bleeding. Intern Med. 2019; 54 (29): 61-67. doi: 10.2169/internalmedicine. 54.5097.
16. Jensen DM, Ohning GV, Kovacs TOG, et al. Natural history of definitive diverticular hemorrhage based on stigmata of recent hemorrhage and colonoscopic Doppler blood flow monitoring for risk stratification and definitive hemostasis. Gastrointest Endosc. 2016; 83(4): 16-23. doi: 10.1016/j.gie.2015.07.033.
17. Umezawa S, Nagata N, Arimoto J, et al. Contrast-enhanced CT for colonic diverticular bleeding before colonoscopy: a prospective multicenter study. Radiology. 2018; 7: 55-61. doi: 10.1148/radiol.2018172910.
18. Toshinobu Y, et al. Effectiveness of endoscopic hemostasis in preventing diverticular bleeding with extravasation detected by contrast-enhanced computed tomography A single-center retrospective cohort study. Medicine. 2021; 100(8): 25-27. doi: 10.1097/MD.0000000000024736.
19. Gralnek IM, Neeman Z, Strate LL. Acute lower gastrointestinal bleeding. N Engl J Med. 2017; 376: 1054-1063. doi: 10.1038/ajg.2016.41.
20. Mohammed Ilyas MI, Szilagy EJ. Management of diverticular bleeding: evaluation, stabilization, intervention, and recurrence of bleeding and indications for resection after control of bleeding. Clin Colon Rectal Surg. 2018; 31: 243-250 doi: 10.1055/s-0037-1607963.
21. Kazuki Y, Yasutoshi S, Takashi I. Utility of the Gel Immersion Method for Treating Massive Colonic Diverticular Bleeding. Clin Endosc. 2021; 54(2): 256-260. doi:10.5946/ce.2020.081.
22. Kinjo K, Masui T, Hisabe T, et al. Increase in colonic diverticular hemorrhaging and confounding factors. World J Gastrointest Pharmacol Therapy. 2016; 7: 440-446. doi: 10.4292/wjgpt.v7.i3.440.
23. Gilshtein H, Kluger Y, Khoury A, Issa N, Khoury W. Massive and recurrent diverticular hemorrhaging, risk factors and treatment. Int J Surg 2016; 33: 136-139. doi: 10.1016/j.ijsu.2016.07.076.
24. Tsuruoka N, Takedomi H, Sakata Y, Shimoda R. Recent Trends in Treatment for Colonic Diverticular Bleeding in Japan Digestion. 2020; 101(1): 12-17. doi: 10.1159/000504089.
25. Yamada A, Niikura R, Yoshida S, Hirata Y, Koike K. Endoscopic management of colonic diverticular bleeding. Dig Endosc. 2015; 27(7): 20. doi: 10.1111/den.12534.
26. Niikura R, Aoki T, Moriyasu S, Sakurai T, Shimbo T, et al. Role of urgent contrast-enhanced multidetector computed tomography for acute lower gastrointestinal bleeding in patients undergoing early colonoscopy. J Gastroenterol. 2015; 50: 62-72. doi:10.1007/s00535-015-1069-9.
27. Sugiyama T, Hirata Y, Kojima Y, Kanno T, Kimura M, Okuda Y, et al. Efficacy of contrast-enhanced computed tomography for the treatment strategy of colonic diverticular bleeding. Intern Med. 2020; 54: 61-67. doi: 10.2169/internalmedicine.54.5097.
28. Ishii N, Omata F, Nagata N, Kaise M. Effectiveness of endoscopic treatments for colonic diverticular bleeding. Gastrointest Endos. 2018; 87(1): 58-66. doi: 10.1016/j.gie.2017.08.013.
29. Nagata N, Ishii N, Kaise M, Shimbo T, Sakurai T, Akiyama J, et al. Long-term recurrent bleeding risk after endoscopic therapy for definitive colonic diverticular bleeding: band ligation versus clipping. Gastrointest Endosc. 2018; 88(5): 841-853. doi: 10.1016/j.gie.2018.07.018.
30. Okamoto N, Tominaga N, Sakata Y, Hara M, Yukimoto T, Tsuruta S, et al. Lower rebleeding rate after endoscopic band ligation than endoscopic clipping of the same colonic diverticular hemorrhagic lesion: a historical multicenter trial in Saga, Japan. Intern Med .2019; 58(5): 633-638. doi: 10.2169/internalmedicine.1473-18.
31. Kobayashi K, Furumoto Y, Akutsu D, Matsuoka M, Nozaka T, Asano T, et al. Endoscopic Detachable Snare Ligation improves the treatment for colonic diverticular hemorrhage. Digestion. 2020; 101(2): 208-216. doi: 10.1159/000498847.
32. Takahashi S, Inaba T, Tanaka N. Delayed perforation after endoscopic band ligation for treatment of colonic diverticular bleeding. Clin J Gastroenterol. 2020; 13(1): 6-10. doi: 10.1007/s12328-019-01027-0.
33. Vernava AM III, Moore BA, Longo WE, et al. Lower gastrointestinal bleeding. Dis Colon Rectum. 2017; 40: 846–858. doi: 10.1007/BF02055445.
34. Chan DK, Soong J, Koh F, et al. Predictors for outcomes after super-selective mesenteric embolization for lower gastrointestinal tract bleeding. ANZ J Surg. 2020; 86: 59-63. doi: 10.1111/ans.12762.
35. Senadeera SC, Vun SV, Butterfield N, et al. Role of super-selective embolization in lower gastrointestinal bleeding. ANZ J Surg. 2018; 88: 4-8. doi: 10.1111/ans.14441.
36. Musinov IM,Chikin AE, Sandursky GV, Kachesov EY. Targeted arterial embolization in the treatment of gastrointestinal ulcer bleeding. Bulletin of Pirogov National Medical &Surgical Center. 2022; 17(3): 42-45. (In Russ.) doi: 10.25881/20728255_2022_17_3_42.
37. Kojima Y, Katano T, Shimura T, Shimohira M, Sugiyama T, Ebi M, Harada T, Yamamoto Y, Hirata Y, Kataoka H. Efficacy of transcatheter arterial embolization for first-line treatment of colonic diverticular bleeding with extravasation on contrast-enhanced computed tomography. Medicine. 2022; 101: 44-46. doi: 10.1097/MD.0000000000031442.
38. Smith R, Copely DJ, Bolen FH. 99mTc RBC scintigraphy: correlation of gastrointestinal bleeding rates with scintigraphic findings. AJR Am J Roentgenol. 2019; 148(5): 869-874. doi: 10.2214/ajr.148.5.869.
39. Dusold R, Burke K, Carpentier W, Dyck WP. The accuracy of technetium-99m-labeled red cell scintigraphy in localizing gastrointestinal bleeding. Am J Gastroenterol. 2021; 89(3): 345-348.
40. Suzman MS, Talmor M, Jennis R, Binkert B, Barie PS. Accurate localization and surgical management of active lower gastrointestinal hemorrhage with technetium-labeled erythrocyte scintigraphy. Ann Surg. 2021; 224(1): 29-36. doi: 10.1097/00000658-199607000-00005.
41. Roberto Cirocchi, et al. New Trends in Acute Management of Colonic Diverticular Bleeding: A Systematic Review Medicine (Baltimore). 2021; 94: 7-10. doi: 10.1097/MD.0000000000001710.
42. Tursi A, Papa A, Danese S. Review article: the pathophysiology and medical management of diverticulosis and diverticular disease of the colon. Alimentary Pharmacology and Therapeutics. 2015; 42: 664-684. doi: 10.1111/apt.13322.
43. Puzanov DP, Polovinkin VV, Puzanova IA, Zebelyan NA. State of the art: diagnosis and treatment for large intestine diverticular disease (approaches and techniques review). Innovative Medicine of Kuban. 2017; 6(2): 54-59. (In Russ.)
44. Tursi A, Papagrigoriadis S. Review article: the current and evolving treatment of colonic diverticular disease. Aliment Pharmacol Ther. 2009; 30: 532-546. doi: 10.1111/j.1365-2036.2009.04072.x.
45. Kabanov MYu, Glushkov NI, Levchuk AL. Surgical gastroenterology in elderly and senile patients. St. Petersburg, 2021. 347-348. (In Russ.)
46. Hah BN, Abdulaev MA, Avdeev AM, Strukov EY, Shchegolev AV, Volchkov VA. Special aspects of intensive care of patients with complicated diverticulosis of the colon. Bulletin of the Russian Military Medical Academy. 2021; (3):149-156. (In Russ.) doi: 10.17816/brmma79633.
47. Butorova LI. Diverticular colon disease: clinical forms, diagnosis and treatment: A manual for doctors. M.: 4TE Art, 2011. Р.48. (In Russ.)
48. Young-Fadok TM, Roberts PL, Spencer MP, Wolff BG.Colonic diverticular disease. Curr Prob Surg. 2000; 37: 459-514. doi: 10.1016/s0011-3840(00) 80011-8.
49. Mayev IV, Dicheva DT, Andreev DN, Lebedeva EG, Baeva TA. Diverticular colon disease. Textbook for doctors Moscow 2015. Р.17 (In Russ.)
50. Osadchuk MA, Svistunov AA. Diverticular colon disease: epidemic of the XXI century. Gastroenterologija. 2014; 1: 10-16. (In Russ.)
