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Diagnostic et prise en charge des hémorragies coliques diverticulaires

Diagnosis and management of colonic diverticular bleeding

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Acta Endoscopica

Résumé

L’hémorragie diverticulaire est la cause la plus fréquente d’hémorragie digestive basse et est en cause dans 35 % des cas. Elle touche le plus souvent la personne âgée. Elle cesse spontanément dans la majorité des cas (90 %), mais peut être sévère et nécessiter le recours à un traitement spécifique et des transfusions. Les hémorragies diverticulaires peuvent engager le pronostic vital avec une mortalité pouvant atteindre 5 % des cas. La coloscopie précoce est un examen de choix pour le diagnostic et le traitement des hémorragies diverticulaires. Une récidive hémorragique s’observe jusque dans 25% des cas à quatre ans. Les facteurs de risque de récidive sont à ce jour mal connus. Le traitement des hémorragies diverticulaires n’est pas clairement codifié, le traitement endoscopique fait appel aux injections de sérum adrénaliné, à la pose de clips ou à la ligature endoscopique. L’embolisation supra-sélective est une alternative efficace en cas d’impossibilité ou d’échec du traitement endoscopique. Une colectomie d’hémostase est rarement nécessaire et ne doit se discuter qu’en cas d’hémorragie non contrôlée par les traitements endoscopiques et/ou radiologiques et après avoir au mieux localisé le siège du saignement.

Abstract

Colonic diverticular bleeding is the most common cause of lower gastrointestinal bleeding representing 35% of cases. It is predominantly a disease of the elderly. Bleeding stops spontaneously in the majority of cases (90%), but sometimes it can be severe and requires specific treatment and blood transfusion. Diverticular bleeding can be life-threatening with a mortality rate of up to 5% of cases. Early colonoscopy is the main examination for diagnosis and treatment of diverticular bleeding. Recurrence occurs in up to 25% of cases within 4 years. Risk factors for recurrence are not clearly understood. Treatment of diverticular bleeding is not clearly codified: serum adrenaline injection, endoclips or endoscopic band ligation have been proposed with a high rate of initial success. Supra-selective embolization is an effective alternative treatment in case of failure of endoscopic treatment. Colectomy to control bleeding is uncommon and should be discussed if bleeding is uncontrolled by endoscopic treatment and/or radiological procedure and if possible after locating bleeding site.

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  1. Service d’hépatogastroentérologie, groupe hospitalier intercommunal Le Raincy-Montfermeil, 10 avenue du Général Leclerc, F-93370, Montfermeil, France

    D. Lorenzo & S. Nahon

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Lorenzo, D., Nahon, S. Diagnostic et prise en charge des hémorragies coliques diverticulaires. Acta Endosc 43, 166–174 (2013). https://doi.org/10.1007/s10190-013-0337-x

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