Diagnosis and Treatment of Sustain Occult Gastrointestinal Bleeding after Appendectomy by Angiography and Arterial Embolization

Abstract

Our patient was a 26-year-old man who was admitted to the hospital with complaints of abdominal pain. The patient had a medical history of propranolol and corticosteroid use. The diagnostic tests were done with suspicion of appendicitis. Under general anesthesia with McBurney's incision appendectomy was performed. We found perforated appendicitis and localized peritonitis. The perforated appendix was excised after ligation of its base. On the day after surgery, the patient's body temperature increased to 39 °C accompanied by mild tachycardia and hypertension (BP=170/90 mmHg) but after 4 days, the patient was discharged with a good general condition. 20 days after discharge, the patient returned to the hospital with weakness and rectorrhagia. The onset of rectorrhagia was 3-4 days before the admission. The patient's vital sign was stable. He reported dizziness and cold sweating. He fainted one time and had jaundice with pale conjunctiva and also complained from epigastric tenderness.

The patient's laboratory finding showed severe anemia (Hb: 5.5 mg/dL, RBC: 2.16 10⁶/µl) with high WBC count and coagulopathy.

Ultrasonic abdominopelvic examination and colonoscopy did not show any specific findings. Ultrasonic evaluation could not detect any fluid in peritoneal or pelvic space but