Effective Methods to Diagnose and Treat Diverticular Hemorrhage in the Small Intestine

diverticulitis
Researchers sought to identify options for diagnosing and treating diverticular hemorrhage, given the current challenges of a quick diagnosis.

Researchers have identified successful ways to diagnose and treat diverticular hemorrhage, the most common cause of small intestine bleeding, according to study results published in the Arab Journal of Gastroenterology.

The retrospective study analyzed data of patients with intestinal hemorrhage admitted to a hospital in China from 2008 to 2014. Researchers reviewed data regarding the patients’ general characteristics, including age at presentation, sex, body mass index, and comorbidities.

Primary outcomes included adverse events, such as anastomotic leakage, anastomotic bleeding, and small bowel obstruction postsurgery.

A total of 85 patients were admitted with intestinal bleeding, of whom 45 were diagnosed with small intestine diverticular hemorrhage. Ten of the patients with diverticular hemorrhage who also had hemodynamic instability were treated with digital subtraction angiography (DSA). Contrast-enhanced computed tomography (CT) scan was used in 16 patients with massive intestinal bleeding, who did not present with hemodynamic instability. Double balloon enteroscopy or wireless capsule enteroscopy was performed in the remaining 19 patients, who had significantly less severe — but persistent — blood loss and presented with chronic anemia.

All 45 patients underwent surgery. In 17 cases (mean age, 45.3±9.1 years; 9 men) diverticulectomy was performed, and in 28 cases (mean age, 43.8±7.8 years; 16 men) segmental intestinal resection was performed.

The mean operation times were 45.7±13.6 minutes for diverticulectomy and 52.8±15.2 minutes for segmental intestinal resection. No statistical difference was found between the procedures’ operation times (t=1.12, P =.34). The mean blood loss was 35.7±10.7 mL and 40.5±9.8 mL for patients who had diverticulectomy and segmental intestinal resection, respectively, with no significant difference in mean blood loss observed between the 2 groups (t=1.02, P =.58).

The length of hospital stay was 5.7±1.4 days for patients who had a diverticulectomy and 6.1±1.8 days for those who had segmental intestinal resection. No significant difference in the length of hospital stay was found between the 2 groups (t=0.78, P =.65). All participants had a minimum follow-up of 3 years, and no cases of recurrent gastrointestinal hemorrhage occurred.

After the specimens were stained with hematoxylin and eosin, 12 showed Meckel diverticula, and the resection margins were free of gastric mucosa. The other 33 specimens were pseudodiverticula, which lacked or had poorly developed muscularis propria and adventitia.

Study limitations included using a single center. Multicenter clinical trials are needed for further validation, the researchers noted.

“…[O]ur study showed that the most common reason for intestinal hemorrhage is a bleeding diverticulum,” the study authors concluded. “The diagnosis can be confirmed by examination using CT, DSA, or endoscopy, depending on the condition of the patient. Diverticulectomy is an effective treatment; the extent of the resection should be based on the size and location of the diverticulum, and the surgical margins must be free. The prognosis of the patients with diverticular hemorrhage in this study was good, and no recurrent bleeding was noted.”

Reference

Luo Y, Huang Y, Sun F, Luo Y. Diagnosis and treatment of diverticular hemorrhage in small intestine: a retrospective study. Arab J Gastroenterol. Published online April 23, 2022. doi:10.1016/j.ajg.2022.02.002