A clinical example of the successful use of hybrid laparoendoscopic technologies for bleeding after electroexcision of an epithelial formation at the mouth of the appendix

Objective. To demonstrate the feasibility and effectiveness of a hybrid laparoendoscopic approach in the management of delayed bleeding from the resection bed of a polyp located at the appendiceal orifice. Material and methods. A 73-year-old female with a laterally spreading epithelial lesion at the appendiceal orifice underwent elective endoscopic mucosal resection (EMR). Results. On the second day after the procedure, the patient developed paroxysmal atrial fibrillation for the first time, for which a direct anticoagulant was prescribed. Following this, bleeding from the bed of the removed polyp developed on the third day. Combined endoscopic hemostasis proved ineffective, so an emergency colonoscopic-assisted laparoscopic wedge resection (CAL-WR) was performed to remove the bleeding source under endoscopic control. Conclusion. The hybrid laparoendoscopic approach may be effectively applied not only for the planned resection of “complex” colorectal polyps, but also, in selected cases, for the management of acute complications, provided that treatment is carried out in a well-equipped hospital setting by an experienced multidisciplinary team.