# Appendicitis after endoscopic band ligation for massive ileocecal hemorrhage

## TL;DR

A patient with massive ileocecal bleeding underwent endoscopic band ligation, which stopped the bleeding but later caused acute appendicitis.

## Contribution

Highlights a rare but important complication of endoscopic band ligation in ileocecal hemorrhage cases.

## Key findings

- Endoscopic band ligation successfully achieved hemostasis for massive ileocecal hemorrhage.
- The procedure was later associated with acute phlegmonous appendicitis.
- Poor visibility during the procedure may increase the risk of this complication.

## Abstract

A 68‐year‐old man was admitted with hematochezia. Emergency computed tomography showed multiple diverticula throughout the colon. Initial colonoscopy on day 2 showed no active bleeding, but massive hematochezia on day 3 led to the performance of an emergency endoscopy. Substantial bleeding in the ileocecal area obscured the visual field, making it challenging to view the area around the bleeding site. Two endoscopic band ligations (EBLs) were applied at the suspected bleeding sites. Hemostasis was achieved without active bleeding after EBL. However, the patient developed lower right abdominal pain and fever (39.4°C) on day 6. Urgent computed tomography revealed appendiceal inflammation, necessitating emergency open ileocecal resection for acute appendicitis. Pathological examination confirmed acute phlegmonous appendicitis, with EBLs noted at the appendiceal orifice and on the anal side. This case illustrates the efficacy of EBL in managing colonic diverticular bleeding. However, it also highlights the risk of appendicitis due to EBL in cases of ileocecal hemorrhage exacerbated by poor visibility due to substantial bleeding. Endoscopists need to consider this rare but important complication when performing EBL in similar situations.