Successful Endoscopic Clipping of Appendiceal Orifice Bleeding: A Technical Maneuver to Convert an Emergency to an Elective Procedure

Abstract

Objective: We report a rare case of an elderly man with appendiceal bleeding successfully treated with endoscopic placement of hemoclips. Methods: We describe the patient’s clinical presentation, laboratory test results, imaging, and treatment. Results: An 89-year-old man presented with two episodes of bloody diarrhea that occurred two hours apart. Colonoscopy revealed active bleeding from the appen- diceal orifice. Hemostasis was achieved with epinephrine injections followed by placement of five hemoclips to effectively close the appendiceal orifice. An abdominal computed tomography (CT) showed an irregular thick- ening of the appendix wall, raising the possibility of an appendiceal mass. On hospital day 4, the patient underwent appendectomy and partial cecectomy. Pathology revealed focal ulceration of the mucosa without malig- nancy. The remainder of the patient’s hospital course was uneventful.Conclusion: The endoscopic methods used in our case proved effective in achieving hemostasis and allowed the patient to be stabilized prior to surgery. It is unclear whether longer monitoring would reveal any possible long-term complications after endoscopic closure of the appendix. It would be of interest to further investigate this approach to assess the long-term safety and efficacy of this procedure.