Abstract
A 56-year-old man, who was referred to the Department of Medicine in our hospital for close exploration of fresh blood at diarrhea in December 2011, was found having multiple diverticula in the ascending colon by colonoscopy. We confirmed that the blood gushed out of one of these diverticula and stopped the bleeding by clipping. In addition, fresh blood was found from a proximal part of it. Further exploration of the intestine up to the cecum revealed pulsatile bleeding from the orifice of the appendix. Clip hemostasis was difficult and her anemia had progressed. On the same day, an emergency operation (partial excision of cecum including the appendix by laparotomy) was performed. Macroscopic findings of the resected specimen disclosed three diverticula in the appendix, and mucosa in only one of the diverticula was noted to turn red. Pathology could not identify any demonstrable ruptured vessels in the area, but we diagnosed the case as bleeding from a true diverticulum of the vermiform appendix because the diverticulum has thinned muscle layer. Diverticulosis of the appendix is a rare entity and preoperative diagnosis is difficult. Bleeding from such a diverticulum is much rarer. Here we present our recent experience with a case of bleeding from pseudodiverticulum of the ascending colon and true diverticulum of the vermiform appendix occurred simultaneously.
