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Acute diverticular colonic bleeding: endoscopic hemostasis

Authors

Gf Donatelli, P Dhumane, S Perretta, B Dallemagne

Abstract

Diverticular disease, angiodysplasia, polyps, hemorrhoids, and anal fissures are the most common causes of lower gastrointestinal bleeding. This video shows the hemostasis of a bleeding originating from a colic diverticulum.

Keywords

Acute diverticular colonic bleeding, endoscopic hemostasis

Media type

Duration

02'57''

Publication

2011-11

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E-publication

WeBSurg.com, Nov 2011;11(11).
URL: http://www.websurg.com/doi-vd01en3451.htm

Acute diverticular colonic bleeding: endoscopic hemostasis

1. Clinical case 00'19''

An 86 year-old man was admitted to the emergency department for rectorrhagia. His vital parameters were stable and hemoglobin was 10.1 g/dL. He exteriorized old and fresh blood all night long and early in the morning hemoglobin reached 9.0 g/dL.

2. Rectosigmoidoscopy 00'40''

A rectosigmoidoscopy was carried out in emergency without anesthesia. Fresh and old blood was visualized on the rectosigmoid wall as well as 30cm away from the anal verge. An active bleeding inside a diverticulum was noted.

3. Arterial bleeding identification 00'59''

Thanks to the waterjet pump, the area was cleaned thoroughly and an arterial bleeding was confirmed.

4. Clip placement 01'12''

For hemostatic purposes, 6 clips (manufactured by Olympus®) were placed on the diverticula to close the orifice, resulting in a mechanical tamponade. The hemostasis was partially controlled.

5. Adrenaline injection 01'42''

To do so, 15 cc of adrenaline was injected (1:20000). The hemostasis was achieved. The lesions were observed for three minutes and no bleeding was observed. The patient exteriorized old blood throughout the day and on the following day, hemoglobin was stable at 9.2 g/dL. He was discharged 2 days after the hemostasis. No more bleeding occurred after a 3-month follow-up.

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