Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Nov 7, 2008; 14(41): 6413-6417
Published online Nov 7, 2008. doi: 10.3748/wjg.14.6413
Therapeutic barium enema for bleeding colonic diverticula: Four case series and review of the literature
Jun-ichi Iwamoto, Yuji Mizokami, Koichi Shimokobe, Takeshi Matsuoka, Yasushi Matsuzaki
Jun-ichi Iwamoto, Yuji Mizokami, Koichi Shimokobe, Takeshi Matsuoka, Yasushi Matsuzaki, Department of Gastroenterology, Tokyo Medical University Kasumigaura Hospital, Chuo 3-20-1, Ami, Inashiki, Ibaraki 300-0395, Japan
Author contributions: Iwamoto J and Mizokami Y contributed equally to this work; Iwamoto J, Mizokami Y, Matsuoka T and Matsuzaki Y designed the research; Iwamoto J and Shimokobe K performed the research; Iwamoto J wrote the paper.
Correspondence to: Jun-ichi Iwamoto, MD, Fifth Department of Internal Medicine, Tokyo Medical University, Chuo 3-20-1, Ami, Inashiki, Ibaraki 300-0395, Japan. junnki@dg.mbn.or.jp
Telephone: +81-298-871161 Fax: +81-298-883463
Received: August 12, 2008
Revised: September 22, 2008
Accepted: September 29, 2008
Published online: November 7, 2008
Abstract

The prevalence of diverticular diseases of the colon, including severe and persistent bleeding in Eastern countries, has increased in the last decades. The bleeding from colonic diverticula is the most common cause of acute lower gastrointestinal bleeding. Herein, we report four cases of severe and persistent bleeding of colonic diverticular disease that could be treated with a high concentration barium enema. These four cases showed a similar pattern of bleeding whose source could not be identified. Colonoscopy revealed fresh blood in the entire colon and many diverticula were noted throughout the colon. No active bleeding source was identified, but large adherent clots in some diverticula were noted. After endoscopic and angiographic therapies failed, therapeutic barium enema stopped the severe bleeding. These patients remained free of re-bleeding in the follow-up period (range 17-35 mo) after the therapy. We report the four case series of therapeutic barium enema and reviewed the literature pertinent to this procedure.

Keywords: Therapeutic barium enema; Colonic diverticula; Diverticular bleeding