Massive hemorrhage from colonic diverticula caused by arterial erosion: A practical theory of its mechanism and causation

Abstract

Summary Two cases of massive hemorrhage from colonic diverticula are reported in which an eroded artery has been demonstrated as the source of bleeding. Eight previously reported cases have been reviewed. Diverticula of the ascending colon and cecum appear to have a predilection for arterial rupture and subsequent massive bleeding. The importance is stressed of bowel sterilization in patients with massive gastrointestinal hemorrhage in whom surgery is anticipated. The value of multiple colotomies and segmental clamping of the colon while attempting to determine the site of hemorrhage, as described by Maynard and Voorhees, is emphasized. The following theory of the causation of arterial erosion in diverticulosis is advanced: The diverticula grow larger, as they become filled by feces or fecaliths, and impinge on the adjacent artery. When this occurs, pulsations of the artery against the diverticulum filled by the unyielding fecal mass causes pressure necrosis of the intervening walls of the artery and the diverticulum, with resultant hemorrhage into an apparently uninflamed diverticulum.