Diverticulitis and hemorrhagic

Abstract

Diverticular hemorrhage is the most frequent cause of lower gastrointestinal bleeding, particularly in elderly individuals with diverticular disease. This is common in older individuals, although most remain asymptomatic, a minority develop complications such as diverticulitis or diverticular hemorrhage (5%).1,2 Unlike diverticulitis, diverticular hemorrhage usually occurs without inflammation or abdominal pain and manifests suddenly, whithout pain, with large amounts of hematochezia. Diverticular hemorrhage arises due to the rupture of the vasa recta in the circular muscular layer, small arteries that cross the wall of the colon and which, over time, undergo changes in their layers, becoming susceptible to spontaneous rupture and consequent hemorrhage. The severity of the bleeding is variable, ranging from self-limiting to potentially fatal massive bleeding, recurring frequently. The main risk factors include advanced age, male sex, high blood pressure, obesity, and the use of non-steroidal anti-inflammatory drugs or antiplatelet medications. Initial treatment consists of hemodynamic stabilization of the patient, with volume replacement and transfusion, if indicated. After stabilization, colonoscopy is the diagnostic and therapeutic method of choice, allowing identification of the bleeding site and application of endoscopic therapies. The image presented is an example of a more extreme case. In this photograph of the endoscopic procedure, it is possible to see more than six diverticula that are hemorrhagic foci, all located peripherally to each other in such a way that they are captured in a single image. This specific clinical case was stabilized with the initial treatment.