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Risk of recurrence and long-term outcomes after colonic diverticular bleeding

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Diverticular disease is one of the most common causes of acute lower gastrointestinal bleeding. We aimed to evaluate the natural history, follow-up, and risk factors associated with re-bleeding (recurrence) in patients with colonic diverticular bleeding.

Methods

We reviewed patients with proven colonic diverticular hemorrhage from September 1993 to June 2012 at our institution. Recurrence was the main outcome measure.

Results

We identified 78 out of 95 patients with proven diverticular bleed who were treated non-operatively and were followed up for a median of 57.1 months. Thirty-seven (47 %) of these patients with a median age of 67 years developed recurrent diverticular bleed after a median time of 8.1 months. The bleeding originated from the left colon in 78 (83 %) out of 95 patients in the first bleeding episode and 31(84 %) out of 37 patients during the recurrent bleeding episode. Thirty-six patients (97 %) with recurrent diverticular bleed required surgical intervention. Old age at the time of initial bleeding was associated with recurrence (p = 0.001). Patients with diverticulitis (p < 0.0001), peripheral vascular (p = 0.01), and chronic renal diseases (p = 0.047) were found to have an increased risk for recurrent colonic diverticular bleed. We only had one perioperative mortality due to postoperative sepsis. All other mortalities were not directly associated with surgery.

Conclusion

Patients with a history of colonic diverticular bleed are prone to recur shortly thereafter. Certain risk factors including increased age, documented diverticulitis, history of peripheral vascular disease, and chronic renal failure may predispose to recurrence.

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Acknowledgments

This study was supported by the Ed and Joey Story Endowed Chair in Colorectal Surgery.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue A30, Cleveland, OH, 44195, USA

    Erman Aytac, Luca Stocchi, Emre Gorgun & Gokhan Ozuner

Authors
  1. Erman Aytac
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  2. Luca Stocchi
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  3. Emre Gorgun
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  4. Gokhan Ozuner
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Corresponding author

Correspondence to Gokhan Ozuner.

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Aytac, E., Stocchi, L., Gorgun, E. et al. Risk of recurrence and long-term outcomes after colonic diverticular bleeding. Int J Colorectal Dis 29, 373–378 (2014). https://doi.org/10.1007/s00384-013-1804-8

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