Special aspects of intensive care of patients with complicated diverticulosis of the colon

Abstract

This study presented examination and treatment results of 129 patients with bleeding from the lower gastrointestinal tract who were treated at the Alexandrovskaya Hospital of St. Petersburg in the period from 2012 to 2017. Examination and treatment were performed in the intensive care unit following current clinical guidelines, taking into account the identified concomitant diseases. Endoscopic examination of the colon is the main diagnostic method for the pathological processes that caused bleeding from the lower gastrointestinal tract. Conservative therapy has been demonstrated effectiveness, and urgent surgical treatment was not needed. The main drug therapy included antifibrinolytic drugs and fresh-frozen plasma preparations. Continuous parenteral administration of proteolysis inhibitors was mandatory. Intensive therapy included correction of hemodynamic disturbances and respiratory failure and restoration of the volume of the circulating blood and plasma. Such an approach was found to be 90% effective. In patients with diverticular disease, bleeding from the colonic diverticula develops in one-third of cases. However, if additional risk factors are present, their frequency reaches 50%, often causing death. Continuous or recurrent bleeding is an indication of surgery. In our study, the conservative method of stopping bleeding from the colonic diverticula was possible in all cases. In general, the disease correlated with the age of the patients. In 68 (53%) patients, bleeding occurred despite anticoagulant or antiplatelet therapy. Patients with bleeding from colonic diverticula do not require urgent surgical intervention, and these patients may require admission to the intensive care unit. Intensive care should include the provision of antifibrinolytic drugs, proteolysis inhibitors, and fresh-frozen plasma.

Keywords

colon diverticulosis / diverticular disease / bleeding from diverticula / surgical treatment / conservative therapy / intensive care / anticoagulants / antiplatelets

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