“Long‐hood method” for identification of the bleeding site in colonic diverticular hemorrhage

Abstract

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Brief Explanation

A problem that is encountered during the clinical course of colonic diverticular hemorrhage (CDH) is the low rate of bleeding site identification, especially after bleeding spontaneously stops. Effectiveness of a transparent hood attached to the colonoscope tip for bleeding site identification has been reported;1, 2 however, the conventional “hood method” cannot be used to visualize the inside of the diverticulum, for example, in the case of a small orifice.3

We used a long hood (distal attachment MAJ‐663; Olympus, Tokyo, Japan) for bleeding site identification in CDH (Fig. 1); its wide lumen allows the inside of the suctioned diverticular dome to be visualized. In this “long‐hood method,” the bleeding diverticula are identified by suctioning the diverticular mucosa into the cup of the hood, turning the diverticulum inside out (Video S1).

Figure 1

The long hood (distal attachment MAJ‐663; Olympus, Tokyo, Japan).

An 86‐year‐old woman was admitted with massive hematochezia. Contrast‐enhanced computed tomography showed multiple diverticula and extravasation in the ascending colon. After bowel preparation using polyethylene glycol, urgent colonoscopy was carried out using a water‐jet scope (PCF‐Q260AZI; Olympus),4 and a long hood was attached to the colonoscope tip. Active bleeding was resolved during colonoscopy. We carefully observed each diverticulum using the “long‐hood method,” and an exposed vessel was detected inside the diverticulum in the ascending colon (Fig. 2). Unfortunately, endoscopic treatment was abandoned because of unstable vital signs as a result of vagus nerve reflexes, although bleeding spontaneously stopped as a result. If possible, we attempt to carry out endoscopic detachable snare ligation (EDSL) as the first‐line treatment for CDH. Long hood is an important device for the procedure of EDSL and bleeding site identification using this method causes subsequent EDSL, even if there is active bleeding or poor bowel preparation in urgent colonoscopy.5

Figure 2

In the “long‐hood method,” the bleeding diverticula are identified by suctioning the diverticular mucosa into the cup of the hood.

Thus, the “long‐hood method” facilitated visualization of the inside of the diverticulum, which could not be seen previously, and might aid in identifying the bleeding site and subsequent endoscopic treatment.

Authors declare no conflicts of interest for this article.