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From 1955 through 1966, thirteen patients have required fourteen emergency operations for sixteen episodes of hemorrhage from diverticular disease of the colon. Emergency colectomy was performed on thirteen occasions, and emergency subtotal colectomy was carried out seven times.
Several features of hemorrhage in diverticular disease are emphasized: (1) Clinical diverticulitis is infrequent; (2) diverticulosis of the entire colon is common; (3) diagnosis can be made with relative accuracy; (4) diverticula in the ascending colon are a frequent cause of hemorrhage; and (5) hemorrhage usually subsides spontaneously, but frequently recurs.
Nonoperative management of acute hemorrhage is advised, but may not be successful. If operation is required, we advise (1) removal of all the colon containing diverticula (this usually requires emergency subtotal colectomy); and (2) primary anastomosis, if feasible. Colostomy without colectomy is not advocated.
Operative endoscopy and colotomies are avoided because these methods are usually ineffective, increase the operative risk, and are of questionable value even if the bleeding site is found because of the significant chance of rebleeding if all diverticula are not removed.
Our results indicate that emergency subtotal colectomy is effective, relatively safe, and does not cause significant postoperative morbidity.
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☆This work was supported by the Begole-Brownell Research Fund.
☆☆Presented at the Eighth Annual Meeting of the Society for Surgery of the Alimentary Tract, Atlantic City, New Jersey, June 17 and 18, 1967.
© 1968 Published by Elsevier Inc.