Bleeding colonic diverticula. A reappraisal of natural history and management.

OBJECTIVE: The study was undertaken to correct or reaffirm current recommendations based on old observations of doubtful validity because of their lack of routine colonoscopy, scintigraphy, or angiography.
METHOD: Patterns of bleeding were derived from transfusion records of 78 patients admitted 106 times for lower gastrointestinal bleeding with no detectable cause other than colon diverticula. RESULT: Bleeding stopped spontaneously in 82 of 108 episodes and in 66 of 67 patients requiring less than four units of transfusion on any day. When four or more units were required in a day, 25 of 42 patients required emergency surgery. When a bleeding site was identified and removed, only 1 of 25 patients bled again from another diverticulum. After discharge without surgery, 28 of 73 began to bled again. After "blind" colectomy and ileoproctostomy, four of seven patients developed leaks or abscesses, and two died.
CONCLUSIONS: Bleeding stopped spontaneously in 75% of episodes and in 99% of patients requiring less than four units of transfusion per day. Bleeding continued in 25% of episodes and in most patients who required four or more units per day. Bleeding sites of those patients who continued to bleed were shown by scintigraphy or angiography. When a bleeding diverticulum is removed, rebleeding is rare. "Blind" resection is unsafe.