An unexpected cause of lower gastrointestinal bleeding
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Appendiceal bleeding is a rare cause of gastrointestinal bleeding; however, surgical appendectomy is generally recommended after a colonoscopic diagnosis. Therefore, physicians should keep this finding in mind as one of the possible causes of bleeding from the right colon and in deciding to perform a colonoscopy urgently.

A 54?year?old man with a benign medical history sought evaluation in our emergency department for a painless, massive, bloody stool. His vital signs were normal, except for tachycardia. Computed tomography showed diverticula and high?density contents in the ascending colon and cecum. Diverticular bleeding was suspected, and a colonoscopy was performed emergently. The colonoscopy revealed an abundance of fresh clots in the cecum near the appendiceal orifice. Persistent bleeding from the appendiceal orifice was confirmed with water immersion, but the source of bleeding was not identified and endoscopic hemostasis was not achieved.

An emergency appendectomy was performed, after which the bleeding stopped. Pathologic evaluation of the specimen did not demonstrate the source of appendiceal bleeding, such as erosions, angiodysplasia, inflammation, or tumors. He has not used anticoagulants or analgesics on a regular basis; therefore, the lower gastrointestinal bleeding (LGIB) was diagnosed as idiopathic appendiceal bleeding.

The management of LGIB is usually conservative because the bleeding stops spontaneously in most cases. Despite the rarity, appendiceal bleeding is difficult to recognize using diagnostic modalities other than colonoscopy. Thus, physicians should keep this disease in mind as one of the possible causes of LGIB from the right colon because the colonoscopic diagnosis may be essential in determining the need for surgical intervention.

Source: https://onlinelibrary.wiley.com/doi/full/10.1002/ccr3.3549?af=R
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