L'emorragia massiva da diverticolosi colica.

Translated title of the contribution: Massive hemorrhage caused by colonic diverticulosis

P. L. Colombo, A. Todde, M. Belisomo, C. Bianchi, A. M. Sciutto, S. Tinozzi

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Massive hemorrhage from diverticular disease of the colon is a very difficult problem in abdominal emergency surgery. The pathogenesis of bleeding colonic diverticulosis is strictly correlated to the angioarchitecture of the colonic diverticular wall. Here the vasa recta penetrate the colonic wall from the serosa to the submucosa through connective tissue septa. Injurious factors arising from the colonic or diverticular lumen can produce an eccentric damage to the luminal side with intimal thickening, segmental weakening of the artery and its rupture with massive bleeding. Conventional barium enema is not able to show the source of the hemorrhage in the majority of the bleeding patients; colonoscopy, as primary emergency procedure, has significant positive findings in 41.5%-83.7% of patients. Radionuclide bleeding scans have a sensitivity rate of 86%-94%. Emergency arteriography localizes the bleeding source in higher rates ranging from 58% to 86% and is successful after intraarterial infusion of vasopressin or embolization in 47%-92% of patients. Surgical treatment for continued bleeding from diverticular disease is controversy. Segmental resection should be performed on patients with localized bleeding sources (positive arteriogram). Laparotomy, anterograde irrigation and intraoperative colonoscopy are indicated in patients with multiple bleeding sites and negative arteriography. Because the right colon is the most common site of bleeding in same cases is necessary to perform a subtotal colectomy with ileorectal anastomosis. Blind resections particularly in the elderly patients present high rebleeding rate (> 60%) and high mortality (30%) with sepsis accounting for the majority of deaths.

Original languageItalian
Pages (from-to)89-97
Number of pages9
JournalAnnali Italiani di Chirurgia
Volume65
Issue number1
Publication statusPublished - Jan 1994

Fingerprint

Colonic Diverticulosis
Hemorrhage
Emergencies
Colonoscopy
Angiography
Colon
Tunica Intima
Serous Membrane
Intra Arterial Infusions
Colectomy
Vasopressins
Rectum
Radioisotopes
Connective Tissue
Laparotomy

ASJC Scopus subject areas

  • Surgery

Cite this

Colombo, P. L., Todde, A., Belisomo, M., Bianchi, C., Sciutto, A. M., & Tinozzi, S. (1994). L'emorragia massiva da diverticolosi colica. Annali Italiani di Chirurgia, 65(1), 89-97.

L'emorragia massiva da diverticolosi colica. / Colombo, P. L.; Todde, A.; Belisomo, M.; Bianchi, C.; Sciutto, A. M.; Tinozzi, S.

In: Annali Italiani di Chirurgia, Vol. 65, No. 1, 01.1994, p. 89-97.

Research output: Contribution to journalArticle

Colombo, PL, Todde, A, Belisomo, M, Bianchi, C, Sciutto, AM & Tinozzi, S 1994, 'L'emorragia massiva da diverticolosi colica.', Annali Italiani di Chirurgia, vol. 65, no. 1, pp. 89-97.
Colombo PL, Todde A, Belisomo M, Bianchi C, Sciutto AM, Tinozzi S. L'emorragia massiva da diverticolosi colica. Annali Italiani di Chirurgia. 1994 Jan;65(1):89-97.
Colombo, P. L. ; Todde, A. ; Belisomo, M. ; Bianchi, C. ; Sciutto, A. M. ; Tinozzi, S. / L'emorragia massiva da diverticolosi colica. In: Annali Italiani di Chirurgia. 1994 ; Vol. 65, No. 1. pp. 89-97.
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