Hemorragia digestiva masiva como manifestación de tumor mucinoso apendicular: Reporte de caso

Abstract

We report a case of a 63-year-old male patient in Bogota, Colombia with a one month history of abdominal pain, associated with diarrheal stools, bloody diarrheal, that was admitted to our third level institution with a tendency to hypotension. Endoscopy was performed without lesions or bleeding. Colonoscopy with poor preparation found residual blood in the ileocecal valve without showing a bleeding site. Endoscopy and colonoscopy were performed again, without evidence of active bleeding, with blood remains. A labeled white blood cells scintigraphy reporting low digestive hemorrhage in the proximal segment of the ascending colon. The patient persisted with bloody stools, vasopressor support, transfusion and abdominal pain. He underwent to laparotomy with intraoperative enteroscopy finding appendicular orifice with large bleeding in the cecum and ascending colon and some angiectatic lesions at the distal ileum. It was decided to perform a right hemicolectomy with resection of the terminal ileum with ileotransverse anastomosis, with adequate clinical follow up. Pathological examination confirmed low-grade appendicular mucinous neoplasia, 1cm in diameter, without infiltration, without evidence of ischemic lesions, 11 lymph nodes of fatty tissue without tumor involvement, without other lesions.