Hemorragia digestiva baja grave de origen diverticular / Severe lower gastrointestinal tract bleeding due to diverticulosis

Introducción. La diverticulosis supone la causa más frecuente de hemorragia digestiva baja (HDB) en pacientes adultos de países occidentales. Los objetivos son analizar: 1) el manejo diagnóstico-terapéutico de los pacientes con HDB severa de origen diverticular; 2) valorar la morbimortalidad asociada; 3) analizar la necesidad de cirugía, y 4) valorar los índices de recidiva de la hemorragia tras el alta hospitalaria. Material y métodos. Se revisan retrospectivamente 42 pacientes con HDB grave de origen diverticular. Fueron considerados los siguientes casos: pacientes con rectorragias que requirieron la transfusión de al menos tres concentrados de hematíes y aquéllos pacientes que presentaron un descenso del hematocrito igual o mayor a 10 puntos. Como grupo control se utilizaron 133 HDB graves en pacientes donde las etiologías no eran la enfermedad diverticular colónica. Resultados. Todos los pacientes se estabilizaron con medidas conservadoras excepto uno que precisó cirugía urgente. Se realizó colonoscopia a 39 pacientes siendo lo más frecuente hallar signos recientes de hemorragia con independencia del momento de su realización precoz o tardía. En un caso se realizó tratamiento endoscópico mediante electrocoagulación con láser de Argón. El índice de recidiva de hemorragia tras el alta hospitalaria fue del 31% de los pacientes (n=13), precisando 7 de ellos (16%) reingreso hospitalario. Conclusión. La HDB grave de origen diverticular cede en la mayoría de los casos con tratamiento conservador aunque con un alto porcentaje de recidiva de la hemorragia. La realización de endoscopia precoz no es tan importante como en el resto de causas de HDB grave (AU)

Introduction. Diverticulosis is the most frequent cause of lower gastrointestinal (GI) bleeding in adults in western countries. The aims of the present study were to analyze: 1) the diagnostic and therapeutic management of patients with severe lower GI bleeding due to diverticulosis; 2) associated morbidity and mortality; 3) the need for surgery, and 4) bleeding recurrence rates after hospital discharge. Material and methods. Were retrospectively reviewed 42 patients with severe lower GI bleeding due to diverticulosis. Patients with rectorrhagia requiring transfusion of at least three packed red blood cell units and those with a decrease in hematocrit of 10 points or more were included. As a control group, we used 133 patients with severe lower GI hemorrhage due to causes other than colonic diverticular disease. Results. All patients were stabilized with conservative measures except one who required emergency surgery. Colonoscopy was performed in 39 patients and the most frequent finding consisted of recent signs of bleeding independently of whether colonoscopy was performed early or was delayed. Endoscopic treatment with Argon laser electrocoagulation was performed in one patient. Bleeding recurrence after hospital discharge occurred in 13 patients (31%); of these, seven (16%) required hospital readmission. Conclusion. Severe lower GI bleeding due to diverticulosis can usually be resolved with conservative treatment although the percentage of bleeding recurrence is high. Early endoscopy is not as important as in the remaining causes of severe lower GI bleeding (AU)

[Severe lower gastrointestinal tract bleeding due to diverticulosis]. / Hemorragia digestiva baja grave de origen diverticular.

INTRODUCTION: Diverticulosis is the most frequent cause of lower gastrointestinal (GI) bleeding in adults in western countries. The aims of the present study were to analyze: 1) the diagnostic and therapeutic management of patients with severe lower GI bleeding due to diverticulosis; 2) associated morbidity and mortality; 3) the need for surgery, and 4) bleeding recurrence rates after hospital discharge. MATERIAL AND METHODS: Were retrospectively reviewed 42 patients with severe lower GI bleeding due to diverticulosis. Patients with rectorrhagia requiring transfusion of at least three packed red blood cell units and those with a decrease in hematocrit of 10 points or more were included. As a control group, we used 133 patients with severe lower GI hemorrhage due to causes other than colonic diverticular disease. RESULTS: All patients were stabilized with conservative measures except one who required emergency surgery. Colonoscopy was performed in 39 patients and the most frequent finding consisted of recent signs of bleeding independently of whether colonoscopy was performed early or was delayed. Endoscopic treatment with Argon laser electrocoagulation was performed in one patient. Bleeding recurrence after hospital discharge occurred in 13 patients (31%); of these, seven (16%) required hospital readmission. CONCLUSION: Severe lower GI bleeding due to diverticulosis can usually be resolved with conservative treatment although the percentage of bleeding recurrence is high. Early endoscopy is not as important as in the remaining causes of severe lower GI bleeding.