Appendiceal Bleeding, A Rare Yet Important Cause of Lower Gastrointestinal Bleed.

Background: Lower gastrointestinal bleeding accounts for 20 to 25% of all gastrointestinal bleedings. Appendiceal bleeding is a rare, yet important cause of lower gastrointestinal bleed; in many cases, it can be misdiagnosed as obscure gastrointestinal bleeding. Here, we present a case of appendiceal bleeding in an elderly female.

Case description: A 79-year-old female presented with acute onset of gastrointestinal bleeding of same-day duration. Investigations showed that she had an appendiceal bleed originating from an ulcer secondary to a small appendicolith, which has passed through the appendiceal orifice, combined with her aspirin use. Within 12 hours, a laparoscopic appendectomy was performed. No evidence of malignancy or vascular malformation was detected, and the post-operative course was smooth, with resultant discharge at day 3 after her surgery.

Discussion: For lower gastrointestinal bleeding, it is crucial for the endoscopist to reach the terminal ileum during the colonoscopy, and thoroughly inspect the orifice of the appendix to assess any source of bleed including but not limited to Dieulafoy's lesion, angiodysplasia or any vascular malformation. An effective treatment option for appendiceal bleeding is surgical management with appendectomy. Alternative approaches such as vessel embolization and endoscopic treatment have been reported to successfully control bleeding; nevertheless, the risk of acute appendicitis and recurrent bleeding following these procedures can be challenging to manage, potentially leading the patient to still need a surgical treatment with an appendectomy.

Learning points: Appendiceal bleeding is a rare, yet important cause of lower gastrointestinal bleed; in many cases, it can be misdiagnosed as obscure gastrointestinal bleeding.