Early Colonoscopy and Endoscopic Hemostasis for Suspected Diverticular Bleeding Potentially Avoids Emergency Surgery and Reduces Surgical Morbidity

In cases of presumed diverticular bleeding, early colonoscopy is recommended, as it is both diagnostic and therapeutic. Although precise identification of the acutely bleeding diverticula is uncommon, when identified, successful endoscopic hemostasis can potentially avoid the need for emergency surgery. In cases of rebleeding, this approach also aids surgical planning for segmental colonic resection, avoiding the morbidity associated with a total colectomy. We present a case series of three unique patients who underwent endoscopic hemostasis for diverticular bleeding, with a video vignette demonstrating the technique. Key components include thorough irrigation and cleansing of the unprepared colon; complete colonoscopy with intubation of the terminal ileum to confirm that the bleeding originates from the lower gastrointestinal tract; adrenaline injection around the bleeding site to slow the brisk bleeding; precise localization of the culprit diverticulum; and, finally, application of endoscopic clips to close the opening of the diverticulum. While there have been case reports of endoscopic haemostasis of diverticular bleeding, most use only a single modality for haemostasis and do not include a video vignette demonstrating the technique used. In comparison, our case report involves the use of dual modality and includes a video to demonstrate our technique.