This paper is only available as a PDF. To read, Please Download here.
Abstract
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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Diverticulosis and diverticulitis of the large bowel.Practitioner. 1927; 118: 352
- Massive hemorrhage from diverticula disease of the colon.Canad. J. Surg. 1964; 7: 21
- Diverticular disease of the colon as a cause of severe hemorrhage in the aged.S. Clin North America. 1960; 40: 933
- The management of massive hemorrhage from diverticula disease of the colon.Surg. Gynec. & Obst. 1959; 108: 49
- The management of bleeding diverticula of the colon.Am. J. Surg. 1960; 100 (In discussion of Howard, M. A.): 217
- The management of bleeding diverticula of the colon.Am. J. Surg. 1960; 100: 217
- The significance of diverticula of the colon in massive melena.Arch. Surg. 1957; 74: 571
- Massive hemorrhage from diverticula disease of the colon.Surgery. 1957; 42: 853
- Surgical management of diverticulitis. Collective review.Internat. Abstr. Surg. 1962; 115: 409
- Earlier resection in one stage for diverticulitis of the colon.Am. Surgeon. 1963; 29: 337
- Bleeding in colonic diverticulitis.Am. J. Surg. 1957; 94: 44
- Massive colonic hemorrhage.Minnesota Med. 1961; 44: 41
- Hemorrhage as a complication of diverticulitis.Ann. Surg. 1955; 141: 674
- Rectal hemorrhage; moderate and severe.Ann. Surg. 1962; 155: 794
- Massive hemorrhage from the lower intestinal tract.West. J. Surg. 1956; 64: 646
- Gross hemorrhage from presumed diverticular disease of the colon: results of treatment in 103 patients.Ann. Surg. 1961; 153: 851
- Current attitudes on diverticulitis with particular reference to colonic bleeding.Arch. Surg. 1966; 92: 321
- Melena, a survey of two hundred and six cases.Am. Surgeon. 1954; 20: 458
- Massive hemorrhage from diverticulitis.Dis. Colon & Rectum. 1960; 3: 441
- Diverticulosis and diverticulitis; general consideration and sigmoidoscopic diagnosis.Am. J. Surg. 1951; 82: 583
- Massive hemorrhage due to diverticula of the colon.Am. J. Gastroenterol. 1955; 24: 77
- Methods of therapy of diverticulitis.Surgery. 1956; 39: 712
- Diverticulitis of the right colon: an important surgical problem.Ann. Surg. 1961; 153: 861
- Surgical treatment of twenty patients with gross hemorrhage from presumed diverticular disease of the colon.Am. Surgeon. 1960; 26: 355
- Massive hemorrhage from diverticulitis of the colon.Ann. Int. Med. 1959; 50: 1395
- Management of massive lower gastrointestinal hemorrhage.Am. J. Surg. 1966; 112: 264
- Surgical treatment for diverticulitis.S. Clin. North America. 1965; 45: 667
- Massive hemorrhage from diverticula of the colon with demonstration of a source of bleeding: a case report.Ann. Surg. 1964; 159: 570
- Hemorrhage as a complication of diverticulitis.Ann. Surg. 1955; 141 (In discussion of Noer, R. J.): 674
- Massive bleeding from diverticulosis of the colon.Am. J. Surg. 1956; 91: 911
- Diverticulitis of the right colon.Am. J. Surg. 1961; 101: 61
- An appraisal of resection of the colon for diverticulitis of the sigmoid.Ann. Surg. 1953; 138: 332
- Exsanguinating hemorrhage from diverticulosis of the ascending colon; report of a case.New England J. Med. 1965; 273: 1480
- Bleeding as a complication of diverticulosis or diverticulitis of the colon.Am. Surgeon. 1953; 19: 397
- Diverticular disease of the colon with hemorrhage. A study of 78 cases.Am. Surgeon. 1960; 26: 171
- Colectomy in the treatment of massive melena secondary to diverticulosis; report of a case.Ann. Surg. 1953; 137: 558
- Massive hemorrhage from diverticulosis of the colon.Am. J. Surg. 1958; 95: 813
- Management of massive hemorrhage from the lower gastrointestinal tract.in: Presented at the Cine Clinics at the Clinical Congress of the American College of Surgeons. October 12, 1966 (San Francisco)
- Hemorrhagic diverticulosis.Texas J. Med. 1962; 58: 701
- Rectal hemorrhage; moderate and severe.Ann. Surg. 1962; 15 (In discussion of Noer, R. J. et al.): 794
- Massive hemorrhage from colonic diverticulitis.in: Mayo Clin. Proc.41. 1966: 549
- Principles and safeguards in abdominal surgery of the aged.J.A.M.A. 1956; 160: 1375
- Transverse abdominal incision in aortic operations.Ann. Surg. 1961; 154 (Suppl.): 45
- Current trends in the surgical management of diverticulitis of the sigmoid colon.S. Clin. North America. 1962; 42: 1267
- Observations on diverticula of the colon; a pathological and clinical study.Lancet. 1928; 2: 51
- The incidence of colonic diverticulosis.Am. J. Roentgenol. 1959; 82: 996
- Segmental isolation for massive colonic hemorrhage.Arch. Surg. 1966; 92: 107
- Direct observation of massive arterial hemorrhage form a diverticulum of the hepatic flexure.Gastroenterology. 1959; 36: 642
- The treatment of selected cases of multiple polyps, familial polyposis and diverticula disease of the colon by subtotal colectomy and ileoproctostomy.Surg. Gynec. & Obst. 1956; 103: 136
- Arterial hemorrhage from a large bowel diverticulum.Gastroenterology. 1956; 31: 210
- The management of complications of diverticulitis of the colon.S. Clin. North America. 1955; 35: 451
- Management of massive lower gastrointestinal hemorrhage.Am. J. Surg. 1966; 112 (In discussion of Albo, R. J., Grimes, O. F. and Dunphy, J. E.): 264
- Colotomy and coloscopy in the mangement of mucosal polyps and cancer of the colon.Am. J. Surg. 1955; 90: 846
- Complications of colotomy and polypectomy.Surg. Gynec. & Obst. 1960; 111: 726
- Prevention of infection in colon surgery.Arch. Surg. 1966; 93: 226
- Use of arteriography in the diagnosis of occult gastrointestinal and traumatic intra-abdominal hemorrhage.Am. J. Surg. 1967; 113: 137
Boyden, A. M. Personal communication. March 6, 1967.
- Surgical management of colonic diverticulitis.Arch. Surg. 1967; 94: 619
- Diverticular disease of the colon: viewpoint concerning its surgical management.Am. Surgeon. 1962; 28: 67
Article info
Footnotes
☆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.
Identification
Copyright
© 1968 Published by Elsevier Inc.
