Bokhari M, Vernava A M, Ure T, Longo W E
Department of Surgery, St. Louis University School of Medicine, Missouri, USA.
Dis Colon Rectum. 1996 Feb;39(2):191-5. doi: 10.1007/BF02068074.
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.
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.
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).
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.
老年患者常因憩室病继发下消化道出血。这一特定群体对失血的耐受性往往较差，常伴有心血管疾病，且可能无法耐受手术干预。因此，老年憩室出血患者的最佳治疗仍很困难。
确定过去60个月内在圣路易斯大学附属医院因憩室病诊断入院的所有患者。提取出有憩室出血的患者。对患者的年龄、性别、憩室出血诊断、出血发作次数、输血前最低血红蛋白水平、输血量、治疗方法、手术情况、复发性出血情况、发病率和死亡率进行回顾。
确定了115例连续入院的年龄70岁及以上、因憩室病继发下消化道出血且需要输血的患者。平均年龄为79岁；115例中有26例（23%）年龄超过80岁；115例中有78例（54%）为男性；115例中有39例（34%）曾因憩室出血不止一次入院。平均血清血红蛋白为8.9 g/dl。所有患者均接受了结肠镜检查；115例中有34例（29%）接受了99Tc扫描，其中34例中有18例（54%）接受了动脉造影。18例中有7例（39%）显示出血性憩室病继发造影剂外渗。平均输血量为2.8（范围1 - 17）单位；115例中有21例（18%）需要行肠切除术；21例中有2例（9%）在30天内死亡。其中，115例中有94例未经手术治疗，94例中有3例（4%）死亡。死亡率与初始血红蛋白水平（P = 0.21）、既往憩室出血（P = 0.44）、输血量（P = 0.36）及治疗方式（P = 0.09）无关。
大多数老年憩室出血采用非手术治疗耐受性良好。治疗的成功率和安全性似乎不取决于既往憩室出血史、初始血红蛋白水平或输血量。大多数患者接受非手术治疗。手术干预似乎耐受性良好。
