Complications

• Epidemiology

  • Diverticulosis is the most common cause of lower GI bleeding in adults.

  • Occurs in ∼ 5% of individuals with diverticulosis

• Etiology: erosions around the edge of diverticula

• Clinical findings

  • Painless hematochezia

  • Signs of anemia may be present if recurrent

  • Severe or ongoing bleeding: significant drop in hemoglobin → hemodynamic instability (hypotension, tachycardia, dizziness, reduced level of consciousness)

  • In 70–80% of cases, bleeding ceases spontaneously

• Differential diagnosis: other causes of lower gastrointestinal bleeding (e.g., hemorrhoidal bleeding)

• Treatment: See “Initial management of overt GI bleeding.”

  • Endoscopic hemostasis during colonoscopy (e.g., epinephrine injection, thermal coagulation, ligation)

  • Angiography with vessel embolization

• i.e., diverticulitis

  • Clinical features include left lower quadrant pain, low-grade fever, tender palpable mass, change in bowel habits

  • Downstream complications include GI perforation, abscess, fistula, intestinal obstruction, and pylephlebitis.

Diverticular disease-associated colitis (DAC), also called diverticular colitis or segmental colitis associated with diverticulosis (SCAD)

• Multifactorial inflammation of segments of colonic mucosa and diverticula

• May overlap with IBD and is treated similarly to Crohn disease