Natural history of acute colonic diverticular bleeding: a prospective study in 133 consecutive patients

BACKGROUND: Bleeding recurrence rate after spontaneous haemostasis of colonic diverticular haemorrhage varies in the literature, and a small minority of patients will require endoscopic, radiological or surgical intervention. AIM: To study the natural history of colonic diverticular bleeding in consecutive patients. METHODS: We studied prospectively consecutive patients admitted for colonic diverticular bleeding from 1997 to 2005. Data on age, gender, 30-day mortality, therapeutic modality for bleeding management and subsequent rebleeding were collected. RESULTS: One hundred and thirty-three patients (mean age 75.7 years) were recruited. Bleeding stopped spontaneously in 123 patients (92.4%). A more interventional approach was necessary in 10 patients. Thirty-day mortality rate for first bleeding was 2.25%. Out of the 123 patients managed conservatively and submitted to an average follow-up of 47.5 months, 17 (13.8%) presented at least one recurrent diverticular bleeding. Spontaneous haemostasis was obtained in all recurrent cases except one, who died. The estimated bleeding recurrence rate was 3.8% at 1 year, 6.9% at 5 years and 9.8% at 10 years. CONCLUSIONS: The low estimated rebleeding rate and the fact that rebleeding can be treated conservatively in most cases suggest that an aggressive approach with intervention is not justified.