Diagnostics of diverticular colonic bleeding (review)

AIM: to analyze the published data on the diagnosis of diverticular bleeding and to justify the choice of effective approach for the clinical checkup of these patients.

MATERIALS AND METHODS: a systematic literature search was carried out on electronic data bases Library.ru, PubMed and Cochrane Library 2005–2025. To collect the published data, search queries were used — colonic bleeding OR colonic diverticular bleeding AND colonoscopy AND contrast-enhanced computed tomography AND arteriography AND transabdominal ultrasound AND technetium-99m-tagged red blood cell scanning. Initially, 832 publications were found. After screening and evaluating the abstracts, followed by a study of the full texts of the papers, 66 articles were selected, including 4 meta-analyses, 5 reviews, 34 clinical trials, and 5 clinical recommendations. This article has been prepared in accordance with PRISMA standards.

RESULTS: over the past 20 years, the rate of large intestinal diverticular bleeding has increased significantly in the structure of gastrointestinal bleeding. Recently, early colonoscopy using standard solutions for oral lavage, an endoscopic cap, and a water jet irrigator are recommended as the main method of diagnostics. Contrast-enhanced computed tomography can be chosen as the initial diagnostic method of examination in cases where high-quality emergency colonoscopy cannot be performed, as well as when endoscopic hemostasis is ineffective, when the possible use of transcatheter arterial embolization or surgical intervention is being discussed. The use of selective angiography is justified in case of ongoing massive or prolonged recurrent diverticular intestinal bleeding, when colonoscopy fails to determine the bleeding site.

CONCLUSION: a personalized choice of a diagnostic program for intestinal bleeding should be based on an objective assessment of the severity of the patient’s condition, the use of modern endoscopic and radiation imaging options to identify the causes of bleeding, establish the exact location of the source and perform the necessary high-tech treatment in a multidisciplinary hospital.

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