Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1 Midorigaoka-higashi, Asahikawa, Hokkaido 078-8510, Japan.
BMC Gastroenterol. 2013 Oct 25;13:152. doi: 10.1186/1471-230X-13-152.
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.
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.
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.
起源于阑尾的急性下消化道出血很少见，且通常难以控制，因为通过内镜几乎不可能接近出血点。我们在此描述首例通过向阑尾内注入治疗性钡剂来控制阑尾出血的病例。
一名 71 岁男性因黑便就诊于我院。他因服用抗血小板药物盐酸噻氯匹定已 10 年。急诊结肠镜检查发现阑尾处有出血，认为出血的病变部位存在于阑尾。使用喷涂管将 200 毫升 50W/V%的钡剂喷入阑尾口。出血可立即停止，放射学检查显示钡剂在盲肠和阑尾口积聚。第二天，钡剂积聚消失，且未观察到明显的肛门出血。停止阑尾出血两周后，行阑尾切除术以防止进一步出现难治性出血。患者 10 个月来无任何腹部症状或肛门出血的主诉。
治疗性钡剂灌肠是控制阑尾出血和避免急诊手术（如部分盲肠切除术和半结肠切除术）的有用方法。
