Severe postappendectomy bleeding

Postappendectomy bleeding is a rare and occasionally catastrophic phenomenon. Three cases of bleeding, two into the retroperitoneum and one into the gastrointestinal tract, are reported, and 13 other cases collected from the literature are reviewed. Retroperitoneal hematoma may require reoperation because of infection. Bleeding in the gastrointestinal tract may occur early (mean, 4 days), or late (mean, 7 years). An unligated stump or slippage of the tie around the stump are the main causes of early bleeding. Sixty-six per cent of the patients recovered without further bleeding. All six patients with late rectal bleeding required surgery for control of the bleeder. Causes included ulceration, vascular malformation, or granuloma.