Prospective evaluation of colonic diverticular bleeding in 133 consecutive patients: elective surgery toprevent recurrence is not justified: LTP06

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Aim:The bleeding recurrence rate after spontaneous hemostasis of colonic diverticular hemorrhage varies in the literature from 20% to 38%. These rates support the idea thatpreventive colonic resection might be necessary.Method:Consecutive patients admitted for colonic diverticular bleeding from 1997 to 2005 wereprospectively studied. Data on age, gender, 30 day mortality, therapeutic modality for bleeding management, and subsequent re-bleeding were collected.Results:One hundred and thirty-three patients of mean age 75.7 yearspresenting with 157 diverticular bleeding episodes were recruited. Bleeding stopped spontaneously in 123 patients (92.4%). Interventional approach was necessary in 10 patients (endoscopic treatment in 3, embolization in 4, and surgery in 5). Thirty day mortality for first bleeding was 3%. Out of the 120 patients who were managed conservatively and submitted to a mean follow-up of 39.5 months, 16 (13.3%)presented with recurrent diverticular bleeding. Spontaneous hemostasis could be obtained in all recurrent cases except one (6.25%) who died. The estimated bleeding recurrence rate was 4.1% at 1 year, 8.3% at 5 years and 12.5% at 10 years.Conclusion:The low estimated re-bleeding rate and the fact that re-bleeding could be treated conservatively in thisprospective series argue againstpreventive surgery.

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