Colonoscopic Clipping as a Treatment for Appendiceal Bleeding

Abstract

Bleeding from the appendix has been reported very rarely in patients with lower-gastrointestinal-tract bleeding. In general, after a colonoscopic diagnosis of appendiceal bleeding, laparoscopic or surgical appendectomy would be recommended. Two patients with continuous bleeding from the appendix were treated with partial occlusion of the appendiceal orifice by colonoscopic clipping. In neither case was there evidence of further active bleeding over the following 12 months. This is the first report of such a treatment in the English literature. (Gut Liver 2010;4:411-414)

A complete hemostasis of an appendiceal bleeding in a dialysis patient by an endoscopic traction method using endoscopic clips

“…We have summarized eight cases of previous endoscopic procedures for treating appendiceal bleeding in Table 1. [4][5][6][7][8][9] Within the eight cases, five cases underwent an endoscopic procedure using clips and other cases underwent a barium enema, an intra-appendiceal stent and an intra-mucosal hemostatic agent injection, respectively. All authors [4][5][6][7][8][9] described that occlusive post-procedural appendicitis could occur after the endoscopic procedure.…”

“…[4][5][6][7][8][9] Within the eight cases, five cases underwent an endoscopic procedure using clips and other cases underwent a barium enema, an intra-appendiceal stent and an intra-mucosal hemostatic agent injection, respectively. All authors [4][5][6][7][8][9] described that occlusive post-procedural appendicitis could occur after the endoscopic procedure. To overcome this, they performed partial occlusion of appendiceal orifice with endoscopic clipping; 4 ligated by locating one wing of the clip toward the inside of the appendix opening and the other wing toward the outside instead of ligating the opening appendix completely; 5 intubated a plastic stent into the appendiceal orifice, then wrapped the stent with a detachable snare; 8 and the application of hemostatic spray, 9 respectively.…”

Painless Hematochezia Due to Appendicitis: Case Report and Review of Literature

“…Colonoscopy hemostasis can be used in certain cases of lower gastrointestinal bleeding, there has been two successful case report regarding colonoscopy treatment of appendiceal bleeding until now. In 2010, Il [15] reported two cases of the use of colonoscopic clipping to treat appendiceal bleeding for the first time. In 2011, Il [16] successfully performed endoscopic clipping without any complications in a patient with acute appendiceal bleeding after confirming that there was no evidence of acute appendicitis or other specific lesions around appendix on abdominal CT and colonoscopy.…”

Successful endoscopic treatment of massive bleeding related to the appendiceal stump

“…Angiographic embolization can cause complications such as necrosis of normal mucosa and perforation [3]. Endoscopic procedures such as epinephrine injection, heat coagulation, or argon plasma coagulation carry some risk of bowel microperforation [4]. For these reasons, we preferred endoscopic clipping, and achieved successful hemostasis.…”