Aytac Erman, Stocchi Luca, Gorgun Emre, Ozuner Gokhan
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue A30, Cleveland, OH, 44195, USA.
Int J Colorectal Dis. 2014 Mar;29(3):373-8. doi: 10.1007/s00384-013-1804-8. Epub 2013 Dec 13.
Diverticular disease is one of the most common causes of acute lower gastrointestinal bleeding. We aimed to evaluate the natural history, follow-up, and risk factors associated with re-bleeding (recurrence) in patients with colonic diverticular bleeding.
We reviewed patients with proven colonic diverticular hemorrhage from September 1993 to June 2012 at our institution. Recurrence was the main outcome measure.
We identified 78 out of 95 patients with proven diverticular bleed who were treated non-operatively and were followed up for a median of 57.1 months. Thirty-seven (47 %) of these patients with a median age of 67 years developed recurrent diverticular bleed after a median time of 8.1 months. The bleeding originated from the left colon in 78 (83 %) out of 95 patients in the first bleeding episode and 31(84 %) out of 37 patients during the recurrent bleeding episode. Thirty-six patients (97 %) with recurrent diverticular bleed required surgical intervention. Old age at the time of initial bleeding was associated with recurrence (p = 0.001). Patients with diverticulitis (p < 0.0001), peripheral vascular (p = 0.01), and chronic renal diseases (p = 0.047) were found to have an increased risk for recurrent colonic diverticular bleed. We only had one perioperative mortality due to postoperative sepsis. All other mortalities were not directly associated with surgery.
Patients with a history of colonic diverticular bleed are prone to recur shortly thereafter. Certain risk factors including increased age, documented diverticulitis, history of peripheral vascular disease, and chronic renal failure may predispose to recurrence.
憩室病是急性下消化道出血最常见的病因之一。我们旨在评估结肠憩室出血患者的自然病史、随访情况以及再出血（复发）相关的危险因素。
我们回顾了1993年9月至2012年6月在我院确诊为结肠憩室出血的患者。复发是主要的观察指标。
我们在95例确诊为憩室出血且接受非手术治疗的患者中识别出78例，中位随访时间为57.1个月。这些患者中位年龄为67岁，其中37例（47%）在中位时间8.1个月后出现复发性憩室出血。首次出血发作时，95例患者中有78例（83%）出血源自左半结肠，复发出血发作时，37例患者中有31例（84%）出血源自左半结肠。36例（97%）复发性憩室出血患者需要手术干预。初次出血时年龄较大与复发相关（p = 0.001）。发现患有憩室炎（p < 0.0001）、外周血管疾病（p = 0.01）和慢性肾病（p = 0.047）的患者复发性结肠憩室出血风险增加。我们仅发生1例因术后脓毒症导致的围手术期死亡。所有其他死亡均与手术无直接关联。
有结肠憩室出血病史的患者此后不久容易复发。某些危险因素，包括年龄增加、有记录的憩室炎、外周血管疾病史和慢性肾衰竭，可能易导致复发。
