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The incidence of bleeding from diverticular disease ranges
from 3 to 30%. Haemorrhage is more common when the
whole colon is affected; the source is more frequently in the
right colon. Tipically, the bleeding is massive, with 15% of
the patients admitted in shock. It nearly always stops
spontaneously, but recurrence rate is high. Chronic blood loss
suggests alternative sources. Emergency angiography detects
aetiology and site of the haemorrhage in most of the patients.
Vasopressin infusion can frequently stop the bleeding.
Colonoscopy is profitable only when bleeding stops, after a
rapid clearing of the colon. On the other hand, intraoperative
colonoscopy could be useful in emergency cases when urgent
surgery is clearly indicated. Surgical treatment is requested
only in few patients: segmental resections (generally right
hemicolectomy) are indicated when there is evidence of the
source of the blood loss. In the other cases sub-total or total
colectomy are justified and provide better and safer results.