Donʼt Stop Looking: Lower Gastrointestinal Hemorrhage Secondary to Appendiceal Orifice Bleeding

Abstract

The patient is a 53 year old male who presented to the hospital with anemia and gastrointestinal hemorrhage. The decision was made to pursue an endoscopic work up with upper endoscopy and a colonoscopy. The upper endoscopy was nondiagnostic, however a large amount of hematochezia noted during his colonoscopy. Further work up with a bleeding scan did not reveal active bleeding, prompting us to pursue a capsule endoscopy. There was an area of active bleeding noted in the distal small bowel which led to patient being scheduled for retrograde double balloon enteroscopy. During this procedure, diligent attention was made to irrigate and suction remaining blood throughout the colon. After the cecum was thoroughly cleaned, a slow ooze was noted emanating from the appendiceal orifice. Withdrawal of the scope did not reveal any other potential source of bleeding. The patient subsequently underwent an appendectomy resulting in successful treatment of his hemorrhage. The specimens from surgical pathology did not reveal any obvious abnormality. The patient was subsequently discharged without any signs of overt hemorrhage. Appendiceal orifice hemorrhage is a rare cause of lower gastrointestinal hemorrhage, as there are only few case reports noted in the literature. This type of bleeding can result from ulcers, erosions, angiodysplasias, or malignancy. Appendectomy is generally curative as it was in our patient's case. This case highlights the need to remain persistent while attempting to diagnose an acute lower GI bleed