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Open Access Case report

A therapeutic barium enema is a practical option to control bleeding from the appendix

Youkou Konno1, Mikihiro Fujiya2*, Kazuyuki Tanaka1, Aki Sakatani1, Mizue Shimoda1, Akihiro Hayashi1, Momotaro Muto1, Mitutaka Inoue1, Jun Sakamoto3, Kensuke Oikawa4, Nobuhiro Ueno2, Yuhei Inaba2, Kentaro Moriichi2 and Yutaka Kohgo2

Author Affiliations

1 Department of Internal Medicine, Engaru-Kosei general Hospital, Engaru, Hokkaido 099-0404, Japan

2 Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka-higashi, Asahikawa, Hokkaido 078-8510, Japan

3 Department of Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Hokkaido 065-0033, Japan

4 Department of pathology, Asahikawa-Kosei general Hospital, Asahikawa, Hokkaidō 078-8211, Japan

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BMC Gastroenterology 2013, 13:152  doi:10.1186/1471-230X-13-152

Published: 25 October 2013

Abstract

Background

Acute lower gastrointestinal hemorrhage originating from the appendix is rare and often intractable, because it is almost impossible to approach the bleeding point by endoscopy. We herein describe the first case of bleeding from the appendix, which was successively controlled by a therapeutic barium enema administered into the appendix.

Case presentation

A 71-year-old male visited our hospital because of melena. He has been receiving an anti-coagulation drug, ticlopidine hydrochloride, for 10 years. By an emergency colonoscopy, a hemorrhage was detected in the appendix, and the lesion responsible for the bleeding was regarded to exist in the appendix. Two hundred milliliters of 50 W/V% barium was sprayed into the orifice of the appendix using a spraying tube. The bleeding could thus be immediately stopped, and a radiological examination revealed the accumulation of barium at the cecum and the orifice of the appendix. The barium accumulation disappeared by the next day, and no obvious anal bleeding was observed. Two weeks after stopping the bleeding from the appendix, an appendectomy was performed to prevent any further refractory hemorrhaging. The patient has had no complaints of any abdominal symptoms or anal bleeding for 10 months.

Conclusions

A therapeutic barium enema is a useful procedure to control bleeding from the appendix and to avoid emergency surgery, such as partial cecectomy and hemicolectomy.

Keywords:
Appendix bleeding; Barium enema; Intestinal hemorrhage; Appendicitis