- Email: [email protected]
Endoscopic therapy for acute diverticular hemorrhage
ENDOSCOPIC THERAPY FOR ACUTE DIVERTICULAR HEMORRHAGE
B
A
C A 66-year-old man was admitted with a 1-day history of severe hematochezia. He was not taking aspirin, nonsteroidal anti-inflammatory drugs, or anticoagulants. On presentation, he had orthostatic hypotension and his hemoglobin was 8.8 g/dL (normal: 14-18 g/dL). He was treated with intravenous hydration and blood transfusions and underwent bowel preparation with 1 gallon of polyethylene glycol electrolyte lavage solution administered orally. At colonoscopy fresh blood, blood clots, and large diverticula were seen throughout the colon. A few polyps were incidentally noted. With extensive irrigation, a single actively bleeding diverticulum was identified in the transverse colon (A). A total of 5 mL of epinephrine (1:10,000) was injected around the neck of the diverticulum. Bleeding persisted and a 492
GASTROINTESTINAL ENDOSCOPY
small site was coagulated with a 7F bipolar probe (B), which resulted in homeostasis (C). The area was tattooed with India ink to facilitate identification of the bleeding site in the event that recurrent bleeding would necessitate surgery. The patient had no recurrent bleeding and was discharged 3 days later. Follow-up colonoscopy for polypectomy 3 weeks later revealed the tattoo and a normal-appearing diverticulum. Luis F. Lara, MD Richard S. Bloomfeld, MD Department of Internal Medicine, Section of Gastroenterology Wake Forest University Baptist Medical Center Winston-Salem, North Carolina doi:10.1067/mge.2001.112722 VOLUME 53, NO. 4, 2001
B
A
C A 66-year-old man was admitted with a 1-day history of severe hematochezia. He was not taking aspirin, nonsteroidal anti-inflammatory drugs, or anticoagulants. On presentation, he had orthostatic hypotension and his hemoglobin was 8.8 g/dL (normal: 14-18 g/dL). He was treated with intravenous hydration and blood transfusions and underwent bowel preparation with 1 gallon of polyethylene glycol electrolyte lavage solution administered orally. At colonoscopy fresh blood, blood clots, and large diverticula were seen throughout the colon. A few polyps were incidentally noted. With extensive irrigation, a single actively bleeding diverticulum was identified in the transverse colon (A). A total of 5 mL of epinephrine (1:10,000) was injected around the neck of the diverticulum. Bleeding persisted and a 492
GASTROINTESTINAL ENDOSCOPY
small site was coagulated with a 7F bipolar probe (B), which resulted in homeostasis (C). The area was tattooed with India ink to facilitate identification of the bleeding site in the event that recurrent bleeding would necessitate surgery. The patient had no recurrent bleeding and was discharged 3 days later. Follow-up colonoscopy for polypectomy 3 weeks later revealed the tattoo and a normal-appearing diverticulum. Luis F. Lara, MD Richard S. Bloomfeld, MD Department of Internal Medicine, Section of Gastroenterology Wake Forest University Baptist Medical Center Winston-Salem, North Carolina doi:10.1067/mge.2001.112722 VOLUME 53, NO. 4, 2001