Diverticular hemorrhage in the elderly--is it well tolerated?

PURPOSE

Elderly patients frequently develop lower gastro-intestinal bleeding secondary to diverticulosis. This select group of patients potentially tolerates blood loss poorly, often have coexisting cardiovascular morbidity, and may not tolerate surgical intervention. Thus, optimal management of elderly patients with diverticular hemorrhage remains difficult.

METHODS

All patients who were admitted with the diagnosis of diverticulosis at the St. Louis University affiliated hospitals during the past 60 months were identified. Those with diverticular bleeding were extracted. Patients were reviewed as to age, sex, diagnosis of diverticular bleeding, number of bleeding episodes, lowest hemoglobin before transfusion, amount of blood received, treatment, operations, the presence of recurrent bleeding, morbidity, and mortality.

RESULTS

One hundred fifteen consecutive patients, age 70 years admitted with lower gastrointestinal hemorrhage secondary to diverticulosis who required transfusion, were identified. Mean age was 79 years; 26 of 115 (23 percent) were more than 80 years of age; 78 of 115 (54 percent) were males; 39 of 115 (34 percent) had more than one previous admission for diverticular hemorrhage. The mean serum hemoglobin was 8.9 g/dl. All patients underwent colonoscopy; 34 of 115 (29 percent) underwent 99Tc scanning, of which 18 of 34 (54 percent) underwent arteriogram. Seven of 18 (39 percent) demonstrated extravasation secondary to bleeding diverticulosis. The mean transfusion requirement was 2.8 (range, 1-17) units; 21 of 115 (18 percent) required intestinal resection; 2 of 21 (9 percent) experienced a 30-day mortality. Among those, 94 of 115 were treated without surgery, and 3 of 94 (4 percent) died. Mortality was independent of initial hemoglobin (P = 0.21), previous diverticular hemorrhage (P = 0.44), amount of blood transfused (P = 0.36), and type of treatment (0.09).

CONCLUSIONS

Most diverticular bleeding in the elderly is well tolerated using nonoperative management. Success and safety of treatment does not seem to depend on a history of previous diverticular bleeding, initial hemoglobin, or amount of blood transfused. The majority of patients are treated nonoperatively. Surgical intervention seems to be well tolerated.