S4765 A Novel Hemostatic Approach to Diverticular Bleeding in the Context of Active Diverticulitis

Introduction: Diverticular bleeding is the leading cause of lower gastrointestinal hemorrhage in the United States. It is responsible for 26%–40% of cases and nearly 200,000 hospitalizations annually. Despite its frequency, it is rare for bleeding and diverticulitis to co-occur, and identifying the bleeding source and achieving definitive management can be challenging. Our case presents the use of a relatively new biocompatible synthetic peptide hemostatic agent, PuraStat® (3D Matrix Europe SAS, Caluire-et-Cuire, France), to treat an unusual case of bleeding in a patient with diverticulitis. Case Description/Methods: A 44-year-old man with recurrent diverticulitis and prior sigmoidectomy presented with hematochezia. He was tachycardic and hypotensive but initially stabilized with fluids and antibiotics. Due to recurrent hemorrhage and hemodynamic instability, he was admitted to the intensive care unit. Computed tomography abdomen/pelvis revealed mild intraluminal hemorrhage in the proximal transverse colon with wall thickening and inflammatory fat stranding, consistent with acute diverticulitis. A mesenteric angiogram showed no active extravasation. Colonoscopy identified an ulcerated diverticulum in the transverse colon with a visible vessel and active oozing. Epinephrine was injected and hemoclips deployed, but failed to achieve hemostasis due to poor mucosal adherence. PuraStat was then applied, resulting in successful hemostasis. The patient remained stable, required no further transfusions, and was discharged without complications. Discussion: Bleeding in the setting of diverticulitis is an uncommon cause of gastrointestinal hemorrhage. PuraStat is currently indicated for hemostasis of oozing bleeding in parenchyma of solid organs, vascular anastomoses, and small blood vessels or capillaries of the GI tract. More recent data have shown the effectiveness of PuraStat for upper GI bleeds. However, there is sparse data on its utilization for acute lower GI bleeding. This case was unique in its deviation from more common treatment modalities in diverticular bleeding such as hemoclips and banding, with the successful use of PuraStat. While traditionally not considered the standard treatment of choice, our patient was successfully treated and, through his multimodal hemostatic approach, including the use of PuraStat, was able to avoid rebleeding. Providers should remain aware of the possibility of bleeding to occur in diverticulitis and be cognizant of the various modalities available to aid in hemostasis.