A case of appendiceal bleeding with hemostasis successfully performed by endoscopic-clipping

Abstract

We present a case of a male in his forties with hematochezia. The patient lost consciousness in the outpatient department of our hospital and was transferred to the emergency department. Blood analysis detected anemia and computed tomography identified multiple diverticula along the entire colon. The patient was admitted and conservative therapy initiated. The hematochezia ceased on day 3 and oral intake began. However, hematochezia recurred on day 8 and a therapeutic barium enema was performed; however this did not resolve the melena. The patient developed shock on day 9 and emergency colonoscopy was performed. Intermittent exudative bleeding from the appendiceal orifice was observed. Endoscopic hemostasis by clipping was successfully performed. The patient was discharged from hospital on day 19. Elective appendectomy was performed two months later in order to prevent appendicitis. Pathological examination showed hemorrhage beneath the mucosa and submucosa of the appendix, which was considered to be the bleeding site. Appendiceal bleeding is a rare source of lower gastrointestinal hemorrhage. Fifteen cases have been reported in Japan between 2000 and 2012, and hemostasis by endoscopic clipping has only been successful in three cases.