Endoscopic Hemoclipping
Endoscopic Hemoclipping
Materials and methods
This study was conducted during a 5-year period beginning in January 1994. All patients with UGI bleeding manifested by hematemesis or melena who underwent emergency endoscopy were included in this study. Informed consent was obtained from all patients before enrollment, and this research was carried out in accordance with the Helsinki Declaration as revised in 1989.
After basic life support all patients underwent emergency endoscopy within 12 hours of the onset of UGI bleeding.
Hemoclipping was performed when active bleeding (spurting, streaming or oozing), visible vessels or fresh adhesive clots were found on endoscopic examination. Patients who did not have any of these findings were conservatively treated. Follow-up endoscopy was performed within 24 hours, after 5 days and between 1 and 2 months after the procedure.
Diagnoses
After the result of blood culture was identified as Salmonella typhi, we could make a diagnosis of typhoid fever complicated by massive intestinal bleeding and acute pancreatitis based on elevated serum lipase and computerized tomography (CT) findings.
Interventions
The patient was treated successfully by two repeat colonoscopic hemostasis procedures involving the deployment of hemoclips on ulcers in the terminal ileum and 10-day course of intravenous ciprofloxacin
Outcomes
The patient was stable and reported no further episodes of intestinal bleeding or fever during the follow-up time. In addition, acute pancreatitis, which is a rare complication of typhoid fever, resolved without complication on follow-up CT and a laboratory study.