case_images: PMC11806402_01
case_images: Endoscopic images from Case 1. A. Colonoscopy showing active bleeding from the ascending colon diverticulum. B. Initial hemostasis achieved with direct clipping. C. Rebleeding at the clipped site during repeat colonoscopy. D. Hemostasis achieved using over-the-scope clip over residual clips
case_images: cureus-0017-00000078641-i01.jpg
case_images: PMC11806402_01_cureus-0017-00000078641-i01.jpg
case_images: FIG1
case_images: A colonoscopy performed 15 hours after arrival revealed active bleeding from the ascending colon diverticulum (Figure 1A). Initial hemostasis was achieved through direct clipping (Figure 1B). However, persistent hematochezia the following day necessitated repeated colonoscopy, revealing rebleeding at the clipped site (Figure 1C). Subsequently, an OTSC was applied over the residual clips to achieve hemostasis (Video 1, Figure 1D).
case_images: PMC11806402_02
case_images: Hemostasis with over-the-scope clip (OTSC) following rebleeding after primary direct clip hemostasis in ascending colonic diverticular bleeding (Case 1)
case_images: .jpg
case_images: PMC11806402_02_.jpg
case_images: VID1
case_images: A colonoscopy performed three hours after arrival revealed active bleeding from the ascending colon diverticulum near the cecum (Figure 2A). Subsequently, EBL was successfully performed (Figure 2B). The OTSC was applied to successfully achieve hemostasis (Figure 2C). Clips were also applied over the ulcer base on top of OTSC to prevent recurrent bleeding (Figure 2D).
case_images: Endoscopic images from Case 2. A. Active bleeding from the ascending colon diverticulum near the cecum. B. Successful hemostasis achieved with endoscopic band ligation. C. Immediate hemostasis was achieved with an over-the-scope clip for rebleeding at the endoscopic band ligation site. D. Hemostasis achieved using over-the-scope clips and additional clips for reinforcement
case_images: cureus-0017-00000078641-i02.jpg
case_images: PMC11806402_02_cureus-0017-00000078641-i02.jpg
case_images: FIG2
case_images: Colonoscopy revealed an adherent coagulum at the apex of the OTSC (Figure 3A). Upon removal of the coagulum (Figure 3B), persistent bleeding was observed (Figure 3C).
case_images: PMC11806402_03
case_images: Confirmation of rebleeding from the over-the-scope clip (OTSC) site in Case 2. A. Colonoscopic image showing an adherent coagulum at the apex of the OTSC. B. Image capturing the removal of the coagulum from the OTSC. C. Persistent bleeding observed after coagulum removal
case_images: cureus-0017-00000078641-i03.jpg
case_images: PMC11806402_03_cureus-0017-00000078641-i03.jpg
case_images: FIG3
case_images: Notably, EBL failed due to the rigidity of the bowel wall and insufficient inversion (Figure 4A). OTSC was used to achieve hemostasis (Figure 4B).
case_images: PMC11806402_04
case_images: Endoscopic images from Case 3. A. Failure of initial hemostasis with endoscopic band ligation due to insufficient inversion in an ascending colon diverticulum. B. Hemostasis achieved using over-the-scope clips
case_images: cureus-0017-00000078641-i04.jpg
case_images: PMC11806402_04_cureus-0017-00000078641-i04.jpg
case_images: FIG4
case_images: A colonoscopy performed 49 hours after admission revealed active bleeding from the sigmoid colonic diverticulum (Figure 5A). Subsequently, EBL was successfully performed (Figure 5B). A repeat colonoscopy revealed persistent bleeding at the EBL site with an adherent coagulum (Figure 5C). OTSC was used to achieve hemostasis (Figure 5D).