TITLE:
Usefulness of Contrast-Enhanced CT on Arrival in Colonic Diverticular Bleeding
AUTHORS:
Masanobu Kishimoto, Kenji Maejima, Takashi Muroya, Kentaro Kajino, Hitoshi Ikegawa, Yasuyuki Kuwagata
KEYWORDS:
Colonoscopy, Extravasation, Hemorrhagic Stool
JOURNAL NAME:
Open Journal of Emergency Medicine,
Vol.10 No.3,
August
3,
2022
ABSTRACT: Contrast-enhanced computed
tomography (CT) and colonoscopy are very useful for the diagnosis and treatment of colonic
diverticular bleeding. However, the timing of CT has been reported in few cases.
The aim of this study was to demonstrate the usefulness of contrast-enhanced CT
on arrival in colonic diverticular bleeding. We conducted a review of the data of patients that were diagnosed with
colonic diverticular bleeding between July 2010 and December 2021. Eighty-two
patients (51 males, 31 females, average age 69.1 years) were admitted with
diagnosis of colonic diverticular bleeding after undergoing contrast-enhanced
CT. We retrospectively investigated the relationship between the initial diagnosis
by contrast-enhanced CT on arrival at the hospital
and the results of endoscopic identification. Contrast-enhanced CT showed extravasation of contrast medium in 30
cases. The time from the onset of bloody stool to the implementation of
contrast-enhanced CT was significantly shorter in cases with extravasation
images in the CT (average 7.9 hours) than in cases without extravasation images
in the CT (average 15.3 hours). The
identification rate of diverticular bleeding sites with colonoscopy was
significantly higher in cases with extravasation images in the CT (83%) than in
cases without extravasation images in the CT (36.5%). The final treatment
methods were endoscopic hemostasis in 46 cases, medical treatment alone in 26
cases, transcatheter arterial embolization (TAE) in 8 cases, and surgery in 2
cases. For patients suspected of colonic diverticular bleeding, performing
contrast-enhanced CT early and estimating the bleeding site
before colonoscopy may lead to the success of endoscopic hemostasis. To identify and treat
successfully colonic diverticular bleeding by colonoscopy, the
early use of contrast-enhanced CT before
colonoscopy is highly recommended.