Successful endoscopic hemoclipping of massive lower gastrointestinal bleeding from paratyphoid A fever

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.