Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2015; 21(3): 1040-1043
Published online Jan 21, 2015. doi: 10.3748/wjg.v21.i3.1040
Successful endoscopic hemoclipping of massive lower gastrointestinal bleeding from paratyphoid A fever
Hui Wang, Xiao-Lin Dong, Xiao-Ming Yu, Kyu Sung Chung, Jian-Peng Gao
Hui Wang, Xiao-Lin Dong, Xiao-Ming Yu, Kyu Sung Chung, Jian-Peng Gao, Department of Gastroenterology, The Affiliated YanAn Hospital of Kunming Medical University, Kunming 650051, Yunnan Province, China
Author contributions: Wang H and Yu XM performed the endoscopy; Dong XL received the patient and assisted in collecting the patient’s data; Wang H wrote the manuscript; Gao JP and Chung KS edited the manuscript; all authors read and approved the final manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jian-Peng Gao, MD, Department of Gastroenterology, The Affiliated YanAn Hospital of Kunming Medical University, 245 East Renmin Road, Kunming 650051, Yunnan Province, China. gaojianpengkm@163.com
Telephone: +86-871-63211282 Fax: +86-871-63211282
Received: June 7, 2014
Peer-review started: June 8, 2014
First decision: June 27, 2014
Revised: August 14, 2014
Accepted: September 18, 2014
Article in press: September 19, 2014
Published online: January 21, 2015
Processing time: 227 Days and 5 Hours
Abstract

Paratyphoid fever can be complicated by massive lower gastrointestinal bleeding with ileocolonic ulcerations, which are commonly localized using colonoscopy. The most common manifestations include multiple, variable-sized, round or oval-shaped, punched-out ulcers. Occasionally, massive lower gastrointestinal bleeding can occur from erosion of blood vessels. We present a rare case of severe lower gastrointestinal bleeding due to paratyphoid A fever that was successfully controlled with hemoclippings. A 30-year-old man experienced high fever and hematochezia whose blood culture showed Salmonella paratyphi A. A complete colonoscopy was successfully performed up to the level of the terminal ileum, which showed multiple, shallow, ulcerated lesions over the entire terminal ileum. A bleeding vessel was seen in one of the ulcers, with overlaying blood clots. Endoscopic hemostasis was successfully performed with four pieces of endoclip and without immediate complication. This report highlights the use of colonoscopy and endoscopic therapy with endoclips for lower gastrointestinal bleeding, which should be considered before surgery.

Keywords: Endoscopic hemoclipping hemostasis; Lower gastrointestinal bleeding; Paratyphoid A fever

Core tip: We present a case of severe lower gastrointestinal bleeding due to paratyphoid A fever that was well-controlled by hemoclippings. Although this type of complication is rare with paratyphoid A fever, clinicians should be cognizant of the possibility for intestinal bleeding from the ulcers in the ileum and proximal colon, which can appear as multiple, variable-sized, round or oval-shaped, punched-out ulcers. Colonoscopy and endoscopic therapy with endoclips should be considered before surgery.