Appendicitis Presenting as Acute Lower Gastrointestinal Bleeding

Abstract

Introduction: Appendicitis is the most common acute surgical condition of the abdomen; however, gastrointestinal bleeding is not a complication that is often seen. We report an unusual case of lower gastrointestinal bleeding with active bleeding from the appendix identified on colonoscopy from appendicitis. Case Report: A 63-year-old-woman with history of diverticulosis was admitted with one-day duration of hematochezia. She described a right lower quadrant abdominal pain a week prior to the bleeding which had resolved spontaneously. She had a screening colonoscopy 3 months prior which revealed pandiverticulosis. She was not on any anticoagulants and did not have any nausea, vomiting, fevers, or abdominal pain on presentation. In the ED, the patient was orthostatic and NG lavage was negative for blood. She was afebrile and there were no signs of an acute abdomen. A rectal exam revealed fresh blood. On admission the Hgb was 11.5 g/dl and no evidence of leukocytosis. A bleeding scan showed active bleeding in the cecum/ascending colon. Angiography showed no evidence of active bleeding. A colonoscopy performed after a rapid purge revealed left sided diverticulosis without active bleeding. The cecum and the appendiceal orifice was identified with the appearance of an adherent clot and active oozing of blood from the appendix (fig 1). There was abnormal polypoid appearance of the tissue surrounding the appendix (fig 2). Surgery was consulted and a right hemicolectomy was performed. The pathology revealed a pericecal/periappendiceal abscess. Bleeding from the appendix is a rare cause of lower GI bleeding. Unless there is massive bleeding, an urgent colonoscopy after a rapid purge can be effective in identifying and managing an acute LGIB. The cause of an isolated appendiceal bleed will determine management and surgical outcome. [figure 1][figure 2]Figure 1Figure 2