Page 74 - World Journal of Laparoscopic Surgery

CASE REPORT
Melena Post-laparoscopic Appendicectomy—One of a Kind:

A Rare Case Report

1
Siddartha Gowthaman Subramaniyan , Akshaya HB 2
Received on: 25 October 2021; Accepted on: 06 September 2022; Published on: 07 December 2022

AbstrAct
Melena usually occurs as a result of an upper gastrointestinal bleed, rarely it can be due to bleeding in the small intestine and ascending colon.
Appendicectomy is one of the safest procedures done with overall minimal complication rate of about 5%. In this article, we have discussed
about melena post-laparoscopic appendicectomy, which is one of the rarest complications of the procedure.
Keywords: Appendicectomy, Laparoscopy, Melena.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1514

IntroductIon 1,2 Department of General Surgery, Mahatma Gandhi Medical College
Appendicectomy can be done by open or laparoscopical approach, and Research Institute, Puducherry, India
and is the commonest surgery performed with a very minimal Corresponding Author: Siddartha Gowthaman Subramaniyan,
complication rate. 1 Department of General Surgery, Mahatma Gandhi Medical College and
The postoperative complications are quite rare, with a mean rate Research Institute, Puducherry, India, Phone: +91 9894098987, e-mail:
of 4.6 and 3.3%, respectively, which are intra-abdominal abscesses, sidhugowtham@gmail.com
stump leakage, stump appendicitis, surgical site infections, seromas, How to cite this article: Subramaniyan SG, Akshaya HB. Malena Post-
wound rupture, intestinal damage, medical complications, small- laparoscopic Appendicectomy—One of a Kind: A Rare Case Report.
bowel obstruction due to the formation of adhesions, and paralytic World J Lap Surg 2022;15(3):260–261.
ileus. 2 Source of support: Nil
Though cases with rectal bleeding post appendicectomy had Conflict of interest: None
been reported in the literature, melena post appendicectomy is
one kind of complication as melena as a cause of lower intestinal
bleed is itself a rare complication. 3 The patient on postoperative second day complained of pain,
In this article, we had discussed about melena that occurred black-colored stools suggestive of melena following which UGI
post laparoscopic appendicectomy in a young male patient and scope showed normal study and CECT abdomen was taken, which
its management. showed postoperative inflammatory changes in the form of mild
bowel-wall enhancement, mesenteric fat stranding, and minimal
interbowel-free fluid at the ileocecal junction in the right iliac fossa.
cAse descrIptIon No obvious arterial bleed or pseudoaneurysms were noted. Mild
A 28-year-old male with no known comorbidities or past surgical post-op arterial phase blush near the post-op region was seen which
history, came to the surgical outpatient department with might be suggestive of source of melena (Fig. 2).
complaints of right lower abdominal pain, pricking type of pain,
intermittent, and no aggravating or relieving factors. He also
complained of 2 episodes of vomiting containing food particles,
non-bilious, and non-blood-tinged. History of fever, 1 episode, low
grade, not associated with chills or rigors, resolved spontaneously.
On examination, the abdomen was soft, tenderness present over
the right iliac fossa, with rebound tenderness, bowel sounds
heard, and hernial orifices free. No significant findings in per-
rectal examination following which ultrasound abdomen was
suggestive of acute appendicitis. After routine investigations,
the patient was taken up for laparoscopic appendicectomy under
general anesthesia. Intraoperative inflamed appendix was found
in the right iliac fossa. Histopathology of the specimen shows an
appendix with mucosal ulceration. Lamina propria shows dense Figs 1A and B: Histopathology of specimen: Lamina propria shows
inflammatory composed predominantly of lymphocytes and dense inflammatory composed predominantly of lymphocytes and
eosinophils extending up to the muscularis propria. Serosa shows eosinophils extending up to the muscularis propria. Serosa shows
congested blood vessels (Fig. 1). congested blood vessels

© The Author(s). 2022 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.