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Active diverticular hemorrhage

Case contributed by Henry Knipe
Diagnosis certain

Presentation

Large output PR bleeding since 4 am ?active bleeding.

Patient Data

Age: 80 years
Gender: Male

Extravasation of contrast within the mid sigmoid colon, with pooling on the portal venous phase. Extensive colonic diverticular disease. The remainder of the colon is unremarkable aside from some fecal colonic loading. Incidental duodenal diverticulum.

Liver, spleen, adrenal glands, pancreas are normal. Cholelithiasis. Multiple bilateral non-obstructive renal stones. Multiple simple renal cortical cysts. Prostatomegaly. Left ureterocele or bladder diverticulum with calcification, which may be in the wall or may represent a dependent stone. No free fluid or free gas.

Case Discussion

Hemorrhage is uncommon in diverticular disease, complicating 3-5% of cases. Most commonly (90%) bleeding ceases spontaneously. However, in this case the patient required angioembolisation to control the hemorrhage. 

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