case_images: PMC11131041_01
case_images: Axial contrast-enhanced computed tomography images. (a) There is no swelling or thickening of the appendix wall on admission (yellow arrow). (b) Three days after endoscopic band ligation. The appendix exhibited wall swelling and thickening (red arrow)
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case_images: Emergency contrast-enhanced computed tomography showed multiple diverticula through the whole colon with no sign of extravasation or no swelling of the appendix wall at that time (Figure 1a). Urgent computed tomography revealed appendiceal wall thickening and swelling, indicative of inflammation (Figure 1b).
case_images: Colonoscopy findings. (a) Ileocecal area with a large amount of clotting blood. (b) A marking clip on the side opposite the suspected bleeding site (yellow arrow). (c) Limited visibility after endoscopic band ligation.
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case_images: Because a large amount of blood prevented confirmation of the spatial relationships surrounding the bleeding from an area thought to be a dimple, it proved difficult to determine whether the dimple was the appendiceal orifice or the diverticula (Figure 2a). After placing a marking clip on the side opposite where the blood appeared to be pooling (Figure 2b), we removed the colonoscope and attached the EBL hood (MD-48910B, Sumitomo Bakelite Co. At this time, the ileocecal valve was visible, but the appendiceal orifice was unclear (Figure 2c).
case_images: Surgical findings. (a) Overview. (b) Ligations (yellow arrows) on the appendiceal orifice and the anal side.
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case_images: PMC11131041_01_DEO2-5-e392-g003.jpg
case_images: deo2392-fig-0003
case_images: Two EBLs had ligated the appendiceal orifice and its anal side in the resected pathological specimen (Figure 3a,b) but which was responsible for the initial ileocecal hemorrhage remained unclear.