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Case Reports: Reminder of important clinical lesson
Acute diverticulitis complicated by massive lower gastrointestinal bleeding: a rare diagnostic challenge
  1. Ann Hutchison1,
  2. Yongjin F Lee1,2,
  3. John Eggenberger1 and
  4. Robert Cleary3
  1. 1Department of Surgery, St Joseph Mercy Ann Arbor Hospital, Ann Arbor, Michigan, USA
  2. 2Colon and Rectal Clinic, Swedish Medical Center, Seattle, Washington, USA
  3. 3Department of Colon & Rectal Surgery, St Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan, USA
  1. Correspondence to Dr Ann Hutchison; ahutchison1960{at}gmail.com

Abstract

A man in his 70s presented with acute sigmoid diverticulitis complicated by a large pericolonic abscess abutting the left rectus abdominis muscle. He was admitted for non-operative management. On hospital day 2, he developed haemorrhagic shock from profuse haematochezia. Colonoscopy was not advisable in the setting of acute complicated diverticulitis. Placement of a percutaneous drain into the abscess cavity returned bright red blood, which was concerning for erosion of the diverticular abscess into the left inferior epigastric artery. An urgent diagnostic angiogram showed hyperaemia enveloping the abscess cavity. Haemostasis was achieved by angioembolisation of the left inferior epigastric artery. The patient did well and was discharged with a course of antibiotics in anticipation of an elective sigmoidectomy.

  • GI bleeding
  • Interventional radiology
  • Gastrointestinal surgery

http://dx.doi.org/10.1136/bcr-2022-249988

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    Footnotes

    • Contributors AH involved in writing, editing and conceptualising; YFL involved in writing, editing and conceptualising; JE involved in editing and conceptualising; RC involved in editing and conceptualising.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests RC has received honorarium from Intuitive Surgical, Inc for educational speaking.

    • Provenance and peer review Not commissioned; externally peer reviewed.