Management of an undetectable Diverticular Bleed: A Case Report and Literature review

Abstract

Key Clinical Message Diverticular bleeding is the most common cause of lower gastrointestinal bleeding and accounts for 20.8%–41.6% of cases in the Western world. Management involves initial resuscitation followed by diagnostic assessment. Colonoscopy is the investigation of choice as it localizes the bleed and has the potential to effectively deliver therapeutic interventions. Other diagnostic modalities include flexible sigmoidoscopy, a tagged red blood cell scan, or angiography. In cases where the bleeding source cannot be identified, intraoperative enteroscopy has emerged as a valuable tool for investigating obscure gastroenterology bleeds in specific patients. In this case report, we describe the management of a 77‐year‐old male with recently diagnosed pan‐colonic diverticulosis who presented with multiple episodes of rectal bleeding and syncope. Due to his declining hemodynamic status and failed endoscopy and embolization, he was taken to surgery for a colectomy. Intraoperative colonoscopy was utilized to facilitate accurate identification of the pathology, assessment of anastomotic patency, and detection of surgical complications. This case report attempts to portray how the incorporation of endo‐videoscopy into surgical planning has the potential to enhance patient outcomes and represent a significant advancement in the field of minimally invasive surgery.

Keywords

• colectomy
• colonic diverticula
• flexible sigmoidoscopy
• gastrointestinal bleed
• intraoperative enteroscopy
• red blood cell scan