title: A case of synchronous bleeding from esophageal varices and appendixin a patient with decompensated liver cirrhosis.
abstract: Lower gastrointestinal bleeding is defined as any bleeding localized distally to Treitz's ligament. The massive bleeding from the appendix is extremely rare and only 21 cases described in the English literature.
  
  
  METHODS
  We present a 61-years-old patient with decompensated liver cirrhosis and bleeding from esophageal varices. He underwent band ligation by Six Shooter (Cook Medical, USA). Due to a massive bleeding from the lower gastrointestinal tract and a rapid decline of hemoglobin level to 3 g/dL, angiography was performed. It revealed a bleeding from distal branches of ileocolic artery, confirmed by the followed computed tomography angiography. The patient underwent appendectomy and was discharged in a good condition on the 6th postoperative day.
  
  
  CONCLUSIONS
  The synchronous bleeding from upper and lower GIT should be considered, especially in the cases with portal hypertension. The angiography and computed tomography angiography are valuable diagnostic methods, able to localize the bleeding a thus to reduce the morbidity and mortality.
authors.forename: V
authors.initials: V
authors.lastname: Daskalov
authors.forename: E
authors.initials: E
authors.lastname: Belokonski
authors.forename: G
authors.initials: G
authors.lastname: Popivanov
authors.forename: A
authors.initials: A
authors.lastname: Milchev
authors.forename: K
authors.initials: K
authors.lastname: Denkov
authors.forename: A
authors.initials: A
authors.lastname: Fakirova
mesh_terms: D000792:Angiography; D001062:Appendectomy / Q000379:methods; D001065:Appendix / Q000601:surgery*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000175:diagnosis; D008026:Ligation / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged