Acute GI bleeding from colonic diverticulosis: Is it really right sided?

Introduction: Diverticulosis is one of the most common causes of severe lower GI bleeding. The literature supports severe acute bleeding from diverticulosis originating in the right colon in 70% of cases. Aim: To determine the most common location for bleeding colonic diverticula and assess the most common site of severe bleeding. Methods: The Bleeding Team Data Base, which has been created to prospectively collect information on all patients in our institution with gastrointestinal hemorrhage, was used to identify cases of bleeding colonic diverticula between 1988 and 1996. This information included clinical presentation, hospital course and outcome, endoscopic findings, other diagnostic studies, and surgery. Pre-established criteria are used to define: colonoscopic diagnosis of the bleeding site, anatomic location (right vs left), severity of bleeding, rebleeding, and continuous bleeding. Colonoscopic criteria for bleeding site were: stigmata of recent hemorrhage and their segmental localization. The midtransverse colon was the anatomic border for right vs left-sided locations. Severe bleeding criteria included: continuous bleeding, hemoglobin drop > 2 mg/dl/24h, transfusion > 4 units of blood in the first 24 hours, orthostatism and shock. Statistical analysis was performed with χ². Results: A total of 203 patients were identified (110 M; 93 F) with an age range from 45 to 102 years (mean 73). Colonoscopy was performed in 203 pts (100%), bleeding scan in 33 pts (16%) and angiography in 12 pts (5.9%). 30 pts (14.7%) underwent surgery. Bleeding locations were right sided in 29 pts (14.2%), left sided in 131 pts (54.5%); and indeterminate in 43 pts. Severe bleeding was right sided in 13 pts , left sided in 16 pts and indeterminate in 11 pts. There was no statistical significance in severity of bleeding between right and left sided locations (p > 0.05) Conclusions: 1) Acute bleeding from colonic diverticulosis is more commonly left sided. 2) Severe bleeding was unrelated to right vs left sided location.