BCM
Gastroenterology Grand Rounds - Take Home Lessons
The main lessons to take home concerning this case
are:
1. The most common cause of lower gastrointestinal bleeding
in the elderly is colonic diverticulosis.
2. In patients who are not experiencing massive, ongoing,
bleeding, colonoscopy should be performed to evaluate the source of bleeding
.
3. If massive, ongoing, bleeding is noted, then angiography
or a nuclear medicine bleeding scan should be performed for localization
followed by angiographic or surgical treatment.
4. Nonrandomized case series have shown that endoscopy
may be effective in treating lower gastrointestinal bleeding secondary
to diverticular disease.
5. "Blind" partial colectomies are not recommended
for unclear sources of lower gastrointestinal bleeding, including presumed
diverticular disease. Presumed diverticular bleeding may be best
managed by removal of all diverticula-bearing colon, which usually means
a total abdominal colectomy with ileorectal anastomosis.
