Diagnosis and Treatment of Diverticular Bleeding and Perforation

Keum, Bora

Abstract

Diverticular disease is not uncommon problem in clinical practice, and sometimes causes serious complication such as lower gastrointestinal bleeding or perforation. The severity of both diverticular complications can differ. Most of diverticular bleeding stops spontaneously, but if a massive bleeding is presented, quick and optimal decision to find the focus of the bleeding and to treat the bleeding lesion using colonoscopy, abdominal CT, and angiography should be required. It is important to understand which procedure is indicated and what measures should be considered before moving to the next diagnostic or therapeutic procedures in individual cases. Diverticular perforation usually accompanies abscesses or peritonitis. Based on the CT classification of diverticular perforation, antibiotics and percutaneous drainage can be one of the choices for treatment in abscesses without general peritonitis. In case of free wall perforation and generalized peritonitis, it has been thought that Hartmann's procedure should be carried out. However, recently several reports demonstrated that the less invasive procedure such as laparoscopic lavage can be the treatment option for purulent peritonitis without fecal contamination. Clinical diagnosis and treatment of diverticular bleeding and perforation based on current literature are discussed in this review.