2005 Abstracts: Severe Lower GI Bleeding in a Western Population: Right-Sided Colonic Diverticular Disease Is the Most Common Etiology for Positive Angiography
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Severe Lower GI Bleeding in a Western Population: Right-Sided Colonic Diverticular Disease Is the Most Common Etiology for Positive Angiography
Pierre Charbonnet, Jaroslava Toman, Pascal Gervaz, University Hospital Geneva, Geneva, AE, Switzerland; Christophe Becker, 24 rue Micheli-du-Crest, Geneva, AE, Switzerland; Philippe Morel, University Hospital Geneva, Geneva, AE, Switzerland
SEVERE LOWER GI BLEEDING IN A WESTERN POPULATION: RIGHT-SIDED COLONIC DIVERTICULAR DISEASE IS THE MOST COMMON ETIOLOGY FOR POSITIVE ANGIOGRAPHY
Pierre Charbonnet, Jaroslava Toman, Pascal Gervaz, Christophe Becker, Philippe Morel. Department of Radiology and Surgery, University Hospital Geneva, Switzerland Background: In Western populations, diverticular disease predominantly affects the left colon. This condition may be complicated by hemorrhage and a minority of patients present with severe lower GI bleeding. We hypothesized that massive bleeding was associated with right-sided location of colonic diverticula. Methods: We report herein the clinical presentation of patients who presented with massive lower GI bleeding and underwent selective mesenteric arteriography in our institution between 1992 and 2003. Angiographic findings were retrospectively reviewed by a panel of radiologists and surgeons who were blinded to patients outcome. Angiography was considered positive whenever contrast extravasation was demonstrated. Results: Out of 93 arteriographies performed for severe lower GI bleeding in our institution, 29 (31%) were positive, and twenty of them were due lesions located in the colon. All patients with extravasation had hypovolemic shock at the time of the procedure. Extravasation was related in 8 cases to diverticular disease (5 in the right and 3 in the left side of the colon), and in 5 cases to arteriovenous malformation. 5 out of 8 patients (62.5%) who bled from proximally located diverticula demonstrated positive angiography findings. Conclusion: Acute bleeding complicating diverticular disease in our population was frequently due to lesions located in the proximal colon. Actually, right-sided diverticula was the most frequent final diagnosis in patients who had positive angiographies, and a majority of right colon diverticula which bleed demonstrated contrast extravasation.
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