Côlon & Rectum

, Volume 11, Issue 1, pp 9–12 | Cite as

Prise en charge des hémorragies d’origine diverticulaire

Dossier Thématique / Thematic File
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Résumé

Les hémorragies diverticulaires sont une complication classique de la maladie diverticulaire. Moins fréquentes que les complications infectieuses, elles représentent pourtant la première cause d’hémorragie digestive basse. La prise d’un traitement anticoagulant représente le principal facteur de risque hémorragique. Les données récentes de la littérature apportent peu de complément aux recommandations publiées en 2006. L’hémorragie d’origine diverticulaire est considérée comme grave au-delà d’une transfusion de six culots globulaires. La prise en charge s’articule autour du scanner abdominal et de l’endoscopie. Ces deux examens ont, en urgence, une sensibilité moyenne sur la localisation précise du saignement, mais leur association permet d’améliorer la valeur prédictive positive et la localisation du saignement. Le saignement cède de façon spontanée dans la majorité des cas. Sur le plan thérapeutique, c’est d’abord l’endoscopie qui permet de tarir le saignement. L’embolisation radiologique est plus rarement possible. La chirurgie ne doit intervenir qu’en dernier recours et l’exploration des différents cadrans coliques doit être effectuée pour limiter le geste de résection à une colectomie segmentaire si elle est indispensable.

Mots clés

Hémorragie diverticulaire Coloscopie Embolisation 

Management of colonic diverticular bleeding

Abstract

Colonic diverticular bleeding is a rare but severe complication of colonic diverticulosis. Hemorrhage is considered severe if more than 6 red blood cells units have been administered. Since the French guidelines published in 2006, few advances in terms of bleeding management have been reported. Colonoscopy and angiography associated can improve the predictive value of the site of bleeding. If the hemorrhage usually stops without specific treatment, both colonoscopy and embolization can be considered to avoid surgery. If necessary, systematic exploration of each colonic quadrant is mandatory to limit the colonic resection.

Keywords

Diverticular bleeding Colonoscopy Embolization 

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Copyright information

© Lavoisier 2017

Authors and Affiliations

  1. 1.Service de chirurgie viscérale, CHU d’AngersAngers cedex 9France

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