Langenbeck’s Archives of Surgery

, Volume 387, Issue 2, pp 67–71

Subtotal colectomy with primary ileorectostomy is effective for unlocalized, diverticular hemorrhage

  • Pietro Renzulli
  • Christoph A. Maurer
  • Peter Netzer
  • Hans-Peter Dinkel
  • Markus W. Büchler
Original Article

DOI: 10.1007/s00423-002-0292-z

Cite this article as:
Renzulli, P., Maurer, C.A., Netzer, P. et al. Langenbeck’s Arch Surg (2002) 387: 67. doi:10.1007/s00423-002-0292-z

Abstract

Background. A large proportion of patients with acute colonic diverticular bleeding undergo emergency surgery without successful prior localization of the bleeding site. This study sought to determine the surgical techniques of choice for unlocalized, diverticular hemorrhage.

Methods. We reviewed the data on 42 consecutive patients (median age 76 years, range 44–91) with acute colonic diverticular bleeding operated on between November 1993 and December 2000. Mean follow-up was 4.1 years.

Results. Preoperative localization of the bleeding site was possible in six patients (14%), by colonoscopy in two and by angiography in four. Ten patients underwent segmental colectomy with primary anastomosis (5 "directed", 5 "blind") and 32 subtotal colectomy with primary ileorectostomy (1 "directed", 31 "blind"). Subtotal colectomy is the more extensive surgical procedure (longer resected bowel, greater blood loss), and although it was performed in older patients, there were no significant differences between segmental and subtotal colectomy with respect to operation time, morbidity, mortality, hospital stay, number of bowel movements, continence scores, rebleeding rate, or patient satisfaction.

Conclusions. Subtotal colectomy with primary ileorectostomy for unlocalized colonic diverticular bleeding is a safe and effective surgical procedure providing complete bleeding control and preserving continence.

Diverticular disease Gastrointestinal bleeding Endoscopy Angiography Subtotal colectomy

Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • Pietro Renzulli
    • 1
  • Christoph A. Maurer
    • 1
  • Peter Netzer
    • 2
  • Hans-Peter Dinkel
    • 3
  • Markus W. Büchler
    • 1
  1. 1.Department of Visceral and Transplantation Surgery, Inselspital, University of Berne, Berne, SwitzerlandSwitzerland
  2. 2.Division of Gastroenterology, Inselspital, University of Berne, Berne, SwitzerlandSwitzerland
  3. 3.Department of Diagnostic Radiology, Inselspital, University of Berne, Berne, SwitzerlandSwitzerland
  4. 4.Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, GermanyGermany