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Diverticular Haemorrhage — RACP Adult Medicine MCQ

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EasyGastroenterologyDiverticular HaemorrhageRACP Adult Medicine

A 65-year-old man on anticoagulation for AF presents with sudden onset painless massive rectal bleeding. He passes 500 mL of bright red blood. Colonoscopy (after prep) shows a diverticulum with a visible vessel and adherent clot in the sigmoid colon. What is the most likely diagnosis?

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Correct answer: D — Diverticular bleeding

Sudden onset painless massive rectal bleeding from a diverticulum with visible vessel/adherent clot is acute diverticular haemorrhage — the most common cause of acute lower GI bleeding in adults >60. Bleeding stops spontaneously in 70-80% of cases. Endoscopic haemostasis (clipping, epinephrine injection) for active bleeding or stigmata. Angiographic embolisation for ongoing bleeding with failed endoscopy. Surgery (segmental colectomy) for refractory bleeding.

Reference: GESA – 2024 – Lower GI Bleeding; BSG 2024