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pubmed-article:7978752pubmed:dateCreated1994-12-16lld:pubmed
pubmed-article:7978752pubmed:abstractTextMassive hemorrhage from diverticular disease of the colon is a very difficult problem in abdominal emergency surgery. The pathogenesis of bleeding colonic diverticulosis is strictly correlated to the angioarchitecture of the colonic diverticular wall. Here the vasa recta penetrate the colonic wall from the serosa to the submucosa through connective tissue septa. Injurious factors arising from the colonic or diverticular lumen can produce an eccentric damage to the luminal side with intimal thickening, segmental weakening of the artery and its rupture with massive bleeding. Conventional barium enema is not able to show the source of the hemorrhage in the majority of the bleeding patients; colonoscopy, as primary emergency procedure, has significant positive findings in 41.5%-83.7% of patients. Radionuclide bleeding scans have a sensitivity rate of 86%-94%. Emergency arteriography localizes the bleeding source in higher rates ranging from 58% to 86% and is successful after intraarterial infusion of vasopressin or embolization in 47%-92% of patients. Surgical treatment for continued bleeding from diverticular disease is controversy. Segmental resection should be performed on patients with localized bleeding sources (positive arteriogram). Laparotomy, anterograde irrigation and intraoperative colonoscopy are indicated in patients with multiple bleeding sites and negative arteriography. Because the right colon is the most common site of bleeding in same cases is necessary to perform a subtotal colectomy with ileorectal anastomosis. Blind resections particularly in the elderly patients present high rebleeding rate (> 60%) and high mortality (30%) with sepsis accounting for the majority of deaths.lld:pubmed
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pubmed-article:7978752pubmed:statusMEDLINElld:pubmed
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pubmed-article:7978752pubmed:authorpubmed-author:BianchiCClld:pubmed
pubmed-article:7978752pubmed:authorpubmed-author:TinozziSSlld:pubmed
pubmed-article:7978752pubmed:authorpubmed-author:BelisomoMMlld:pubmed
pubmed-article:7978752pubmed:authorpubmed-author:ColomboP LPLlld:pubmed
pubmed-article:7978752pubmed:authorpubmed-author:ToddeAAlld:pubmed
pubmed-article:7978752pubmed:authorpubmed-author:SciuttoA MAMlld:pubmed
pubmed-article:7978752pubmed:issnTypePrintlld:pubmed
pubmed-article:7978752pubmed:volume65lld:pubmed
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pubmed-article:7978752pubmed:authorsCompleteYlld:pubmed
pubmed-article:7978752pubmed:pagination89-97; discussion 97-8lld:pubmed
pubmed-article:7978752pubmed:dateRevised2006-11-15lld:pubmed
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pubmed-article:7978752pubmed:articleTitle[Massive hemorrhage caused by colonic diverticulosis].lld:pubmed
pubmed-article:7978752pubmed:affiliationCattedra di Chirurgia Apparato Digerente, Università di Pavia-I.R.C.C.S. Policlinico San Matteo.lld:pubmed
pubmed-article:7978752pubmed:publicationTypeJournal Articlelld:pubmed
pubmed-article:7978752pubmed:publicationTypeEnglish Abstractlld:pubmed