Diverticular Hemorrhage also see Gastrointestinal Bleeding Pathophysiology

• Erosion of blood vessel feeding diverticulum by a fecalith

• Diverticula more common in left colon; but bleeding diverticula are often in right colon Clinical manifestations

• Usually painless hematochezia, but can have abdominal cramping

• Usually stops spontaneously ( 75%) but resolution may occur over hrs-days; 20% recur

Physical exam

• Usually benign

Diagnostic studies

• Colonoscopy or angiography • tagged RBC scan if severe bleeding

Treatment (see "Gastrointestinal Bleeding" for persistent bleeding)

• Colonoscopy: epinephrine injection • electrocautery (nejm 2000:342 78). hemoclip. banding

• Arteriography: intraarterial vasopressin infusion or embolization

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