A case of bleeding from a Celecoxib-induced small intestinal ulcer successfully controlled with hemoclipping during emergency colonoscopy

Abstract

An 81-year-old man with myelodysplastic syndrome was hospitalized with a fever of unknown origin. After antibiotic treatment, he improved. He had previously received Celecoxib as a painkiller for a fracture for over a year. Twenty days after admission, he developed sudden onset hematochezia. An emergency colonoscopy revealed multiple, non-bleeding, shallow ulcers in the right colon. Abdominal computed tomography showed highly dense fluid in the terminal ileum. Deeper probing by colonoscopy from the ileocecal valve revealed a nearby, small oozing ulcer with exposed vessels that was subsequently clipped.
Celecoxib has a lower risk of causing mucosal damage than other NSAIDs ; however, its long-term use may increase this risk. In addition, an unknown bleeding site prior to emergency colonoscopy requires the maximal insertion of the colonoscopy.