Active diverticular haemorrhage
Large output PR bleeding since 4 am ?active bleeding.
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Extravasation of contrast within the mid sigmoid colon, with pooling on the portal venous phase. Extensive colonic diverticular disease. The remainder of the colon is unremarkable aside from some faecal colonic loading. Incidental duodenal diverticulum.
Liver, spleen, adrenal glands, pancreas are normal. Cholelithiasis. Multiple bilateral non-obstructive renal stones. Multiple simple renal cortical cysts. Prostatomegaly. Left ureterocoele or bladder diverticulum with calcification, which may be in the wall or may represent a dependent stone. No free fluid or free gas.
Haemorrhage is uncommon in diverticular disease, complicating 3-5% of cases. Most commonly (90%) bleeding ceases spontaneously. However, in this case the patient required angio-embolisation to control the haemorrhage.