급성 하부위장관 출혈로 인하여 진단된 급성 화농성 충수염 1예
Acute Suppurative Appendicitis Diagnosed by Acute Lower Gastrointestinal Hemorrhage
김대하, 이주한, 김동우, 황수현, 강규호, 구자설,
소속 상세정보
김대하 ( Kim Dae-Ha )
고려대학교 안산병원 소화기내과
이주한 ( Lee Ju-Han )
고려대학교 안산병원 병리과
김동우 ( Kim Dong-Woo )
고려대학교 안산병원 소화기내과
황수현 ( Hwang Su-Hyun )
고려대학교 안산병원 소화기내과
강규호 ( Kang Kyu-Ho )
고려대학교 안산병원 소화기내과
구자설 ( Koo Ja-Seol )
고려대학교 안산병원 소화기내과
Abstract
A 49-year-old man visited the emergency room of Korea University Ansan Hospital with hematochezia starting the day before the visit. Recently, he was on anti-platelet medication due to hypertension. The patient had no definite symptoms other than hematochezia. Digital rectal exam was positive and laboratory tests showed severe anemia. Sigmoidoscopy was initiated and almost no fecal material was observed in the intestinal tract, allowing insertion into the cecum. Active bleeding from the appendiceal opening was noted. On abdominal CT, contrast enhancement was observed at the tip of the appendix. Under suspicion of acute appendicitis, we consulted with a surgeon. The patient underwent appendectomy with partial cecal resection. Pathologic examination revealed a diagnosis of appendix bleeding due to acute suppurative appendicitis. The patient had no further bleeding after surgery and was discharged in a stable state. Careful observation by the endoscopist is necessary for accurate diagnosis of lower gastrointestinal hemorrhage. Appendiceal hemorrhage is very rarely reported, but it has various pathophysiologies. CT scan is useful when appendiceal hemorrhage is confirmed by endoscopic findings. Surgical treatment was needed in almost all cases reported worldwide. If bleeding from the appendix is confirmed, surgical treatment should be considered for both therapeutic and diagnostic purposes.
키워드
Gastrointestinal hemorrhage; Appendicitis; Appendix; Colonoscopy; Appendectomya
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