Page 75 - World Journal of Laparoscopic Surgery

Melena Post-laparoscopic Appendicectomy—One of a Kind
abdomen ruled out any active bleed in the abdomen or peritoneal
collection, which would have caused melena. As other causes
are ruled out, the probable cause of melena in our case would
be stump bleed where the patient was closely monitored, where
the symptoms resolved spontaneously after 5 days. Colonoscopy
can also be considered if the patient develops the complication
at a later stage.

conclusIon
In summary, we have presented a very unusual case of melena
post appendicectomy. Although this type of complication is rarest,
but if it is left unattended, the patient might end up with serious
complications, also, unnecessary intervention may result in serious
morbidity for the patient.

Fig. 2: CECT abdomen was taken which showed postoperative references
inflammatory changes in the form of mild bowel wall enhancement, 1. Kirby A, Hobson RP, Burke D, et al. Appendicectomy for suspected
mesenteric fat stranding, and minimal interbowel-free fluid at the uncomplicated appendicitis is associated with fewer complications
ileocecal junction in the right iliac fossa. No obvious arterial bleed or than conservative antibiotic management: a meta-analysis of post-
pseudoaneurysms were noted. Mild post-op arterial phase blush near intervention complications. J Infect 2015;70(2):105–110. DOI: 10.1016/j.
the post-op region was seen, which might be suggestive of the source jinf.2014.08.009.
of melena 2. Andersson RE. Short-term complications and long-term morbidity
of laparoscopic and open appendicectomy in a national cohort. Br J
Melena post appendicectomy is one of the rarest complications. Surg 2014;101(9):1135–1142. DOI: 10.1002/bjs.9552.
Only a handful number of cases have been reported about lower 3. Vo N, Hall FM. Severe post appendectomy bleeding. Am Surg
1983;49(10):560–562. PMID: 6331778.
GI bleed post appendicectomy as mentioned by Koimtzis et 4. Koimtzis G, Sapalidis K, Koletsa T, et al. Massive endoluminal bleeding
4
al., but melena post appendicectomy had never been reported from the invaginated appendiceal stump after appendectomy:
in literature. In our case, upper gastrointestinal bleeding was a unique case of gastrointestinal bleeding. ProClinS Surgery and
ruled out as the cause of melena by upper GI endoscope. CECT Procedures 2018;1(1):1–5.

World Journal of Laparoscopic Surgery, Volume 15 Issue 3 (September–December 2022) 261