Correspondence |
Colonic diverticular haemorrhage is associated with atherosclerosis
Sir,Colonic diverticulosis occurs in the majority of Western populations, but only a small proportion of people experience symptoms. Diverticular disease usually presents with either diverticulitis or haemorrhage. Bleeding from colonic diverticulum is usually massive, and 15% of patients are admitted in shock. However, the aetiology of colonic diverticular haemorrhage remains unknown.
We studied the clinical and biochemical characteristics of patients with complicated diverticulosis admitted to our emergency room in the last 4 years. We saw patients with haemorrhage (n = 10) and with diverticulitis (n = 12), diagnosed using colonoscopy, abdominal computed tomography, angiography, and surgery. We took histories and did blood tests. Patients with diverticulitis showed significantly higher numbers of leukocytes and concentrations of C-reactive protein than patients with haemorrhage (Table 1); in patients with haemorrhage, both parameters were almost within the normal range. Patients with haemorrhage were significantly older than those with diverticulitis, comparing means. Further, we observed a significantly higher prevalence of atherosclerotic diseases among those with haemorrhage (Table 1).
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Diverticula usually develop where intramural branches of the marginal artery supplying the colon penetrate the colon wall. Diverticular haemorrhage has been suggested to occur when the damaged vessel ruptures at the dome or the neck of the diverticulum,1 but the aetiology of vessel damage remains obscure. Our findings indicate the possibility that diverticular haemorrhage is associated with atherosclerosis and ageing but not inflammation. Risk factors for diverticular disease, such as low physical activity, low dietary fibre intake, and high intake of total fat or red meat,2,3 are similar to those for atherosclerosis, supporting this association.
Our study has limitations. Since all patients studied were admitted by ambulance, with severe symptoms such as hypotension, shock, or severe abdominal pain, and the condition is fairly uncommon, the number of subjects was very small. To elucidate this association, further studies, preferably with larger numbers of subjects, will be needed.
Department of Emergency Medicine, The Jikei University School of Medicine, Japan
email: yanaih{at}jikei.ac.jp
References
1. Kethu SR, Rich HG. Bleeding colonic diverticulum. N Engl J Med 2003; 349:25.
2. Aldoori WH, Giovannucci EL, Rimm EB, Ascherio A, Stampfer MJ, Colditz GA, et al. Prospective study of physical activity and the risk of symptomatic diverticular disease in men. Gut 1995; 37:298–9.
3. Aldoori WH, Giovannucci EL, Rimm EB, Wing AL, Trichopoulos DV, Willett WC. A prospective study of diet and the risk of symptomatic diverticular disease in men. Am J Clin Nutr 1994; 60:757–64.
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