The patient is a 48 year old male who presented to the hospital with 12 hours of painless hematochezia and hypotension. Pt also had a normocytic anemia with hemoglobin of 10.2grams. After resuscitation and rapid Golytely purge pt underwent emergent endosocpy. The EGD was normal
Upon withdrawal an actively bleeding diverticulum was found in the descending colon. Bleeding will occur in 15% of patients with diverticulosis with a third of them being massive. There is an associated mortality rate of 10-20%. Bleeding stops spontaneously in 75% of all cases and in 99% of cases where patients are transfused less than 4units per day.
Using a standard injection needle, 2cc of 1:10,000 dilutional epinephrine was injected into the submucosa next to the diverticulum. In this patient hemostasis was achieved after the 1st epinephrine injection with the lavage being clear.
Using a resolution hemoclip the mouth of the diverticulum was approximated and closed resulting in additional mechanical tamponade.
Ramesh Srinivasan, M.D., University of Texas Medical Branch
Gurinder Luthra, M.D., Center for Endoscopic Research, Training and Innovation, University of Texas Medical Branch
Gottumukkala S. Raju, MD, MD Anderson Cancer Center