OJEM  Vol.10 No.3 , September 2022
Usefulness of Contrast-Enhanced CT on Arrival in Colonic Diverticular Bleeding
Abstract: Contrast-enhanced computed tomography (CT) and colonoscopy are very useful for the diagnosis and treatment of colonic diverticular bleeding. However, the timing of CT has been reported in few cases. The aim of this study was to demonstrate the usefulness of contrast-enhanced CT on arrival in colonic diverticular bleeding. We conducted a review of the data of patients that were diagnosed with colonic diverticular bleeding between July 2010 and December 2021. Eighty-two patients (51 males, 31 females, average age 69.1 years) were admitted with diagnosis of colonic diverticular bleeding after undergoing contrast-enhanced CT. We retrospectively investigated the relationship between the initial diagnosis by contrast-enhanced CT on arrival at the hospital and the results of endoscopic identification. Contrast-enhanced CT showed extravasation of contrast medium in 30 cases. The time from the onset of bloody stool to the implementation of contrast-enhanced CT was significantly shorter in cases with extravasation images in the CT (average 7.9 hours) than in cases without extravasation images in the CT (average 15.3 hours). The identification rate of diverticular bleeding sites with colonoscopy was significantly higher in cases with extravasation images in the CT (83%) than in cases without extravasation images in the CT (36.5%). The final treatment methods were endoscopic hemostasis in 46 cases, medical treatment alone in 26 cases, transcatheter arterial embolization (TAE) in 8 cases, and surgery in 2 cases. For patients suspected of colonic diverticular bleeding, performing contrast-enhanced CT early and estimating the bleeding site before colonoscopy may lead to the success of endoscopic hemostasis. To identify and treat successfully colonic diverticular bleeding by colonoscopy, the early use of contrast-enhanced CT before colonoscopy is highly recommended.
Cite this paper: Kishimoto, M. , Maejima, K. , Muroya, T. , Kajino, K. , Ikegawa, H. and Kuwagata, Y. (2022) Usefulness of Contrast-Enhanced CT on Arrival in Colonic Diverticular Bleeding. Open Journal of Emergency Medicine, 10, 149-156. doi: 10.4236/ojem.2022.103013.

[1]   Kruis, W., Germer, C.T., Leifeld, L., et al. (2014) Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery. Digestion, 90, 190-207.

[2]   Kinjo, K., Matsui, T., Hisabe, T., Ishihara, H., Maki, S., Chuman, K., et al. (2016) Increase in Colonic Diverticular Hemorrhage and Confounding Factors. World Journal of Gastrointestinal Pharmacology and Therapeutics, 7, 440-446.

[3]   Schultz, J.K., Azhar, N., Binda, G.A., Barbara, G., Biondo, S., Boermeester, M.A., et al. (2020) European Society of Coloproctology: Guidelines for the Management of Diverticular Disease of the Colon. Colorectal Disease, 22, 5-28.

[4]   Jensen, D.M., Machicado, G.A., Jutabha, R. and Kovacs, T.O. (2000) Urgent Colonoscopy for the Diagnosis and Treatment of Severe Diverticular Hemorrhage. The New England Journal of Medicine, 342, 78-82.

[5]   Strate, L.L. and Gralnek, I.M. (2016) ACG Clinical Guideline: Management of Patients with Acute Lower Gastrointestinal Bleeding. American Journal of Gastroenterology, 111, 459-474.

[6]   Lewis, M. (2008) Bleeding Colonic Diverticula. Journal of Clinical Gastroenterology, 42, 1156-1158.

[7]   Niikura, R., Yasunaga, H., Yamaji, Y., Horiguchi, H., Fushimi, K., Yamada, A., et al. (2015) Factors Affecting in-Hospital Mortality in Patients with Lower Gastrointestinal Tract Bleeding: A Retrospective Study Using a National Database in Japan. Journal of Gastroenterology, 50, 533-540.

[8]   Jaeckle, T., Stuber, G., Hoffmann, M.H.K., Jeltsch, M., Schmitz, B.L. and Aschoff, A.J. (2008) Detection and Localization of Acute Upper and Lower Gastrointestinal (GI) Bleeding with Arterial Phase Multi-Detector Row Helical CT. European Radiology, 18, 1406-1413.

[9]   Kaise, M., Nagata, N., Ishii, N., Omori, J., Goto, O. and Iwakiri, K. (2020) Epidemiology of Colonic Diverticula and Recent Advances in the Management of Colonic Diverticular Bleeding. Digestive Endoscopy, 32, 240-250.

[10]   Thorne, D.A., Datz, F.L., Remley, K. and Christian, P.E. (1987) Bleeding Rates Necessary for Detecting Acute Gastrointestinal Bleeding with Technetium-99m-Labeled Red Blood Cells in an Experimental Model. Journal of Nuclear Medicine, 28, 514-520.

[11]   Kouraklis, G., Misiakos, E., Karatzas, G., Gogas, J. and Skalkeas, G. (1995) Diagnostic Approach and Management of Active Lower Gastrointestinal Hemorrhage. International Surgery, 80, 138-140.

[12]   Pilichos, C. and Bobotis, E. (2008) Role of Endoscopy in the Management of Acute Diverticular Bleeding. World Journal of Gastroenterology, 14, 1981-1983.