Management of colonic diverticular bleeding: A narrative review with literature search of current evidence and therapeutic strategies

Table 8 Indications for surgical intervention in colonic diverticular bleeding and operative strategy selection

Surgical indication/operative strategy	Clinical context/selection principle
Hemodynamic instability refractory to resuscitation	Requires massive transfusion; endoscopic/IR hemostasis not feasible or failed
Transfusion > 10 units pRBC with identified colonic source	Ongoing hemorrhage despite non-operative management
Failed endoscopic and TAE hemostasis	Salvage colectomy; segment identification by intraoperative colonoscopy if feasible
Recurrent life-threatening hemorrhage (localized source)	Elective laparoscopic segmental colectomy preferred
Perforation or surgical complication	Emergent laparotomy; bowel viability assessment required
Segmental colectomy	Preferred when source confirmed by CTA or colonoscopy; lower morbidity, better functional outcome
Total abdominal colectomy (TAC)	Reserved for unlocalized bleeding; 0% rebleeding but significant diarrhea/incontinence rates

pRBC: Packed red blood cells; TAE: Transcatheter arterial embolization; TAC: Total abdominal colectomy; CTA: Computed tomographic angiography; IR: Interventional radiology.