Limits...
Massive lower gastrointestinal bleeding from the appendix.

Chung KS, Gao JP - Gut Liver (2011)

Bottom Line: Massive rectal bleeding from the appendix, considered a rare case of lower gastrointestinal bleeding, is not easily recognized by various diagnostic modalities.A multidisciplinary approach for both a diagnosis and a differential diagnosis is important because the identification of the bleeding site is crucial to proceed to a proper intervention and there are various causes of appendiceal bleeding.We also present a review of the literature.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, The Affiliated YanAn Hospital of Kunming Medical College, Kunming, Yunnan, China.

ABSTRACT
Massive rectal bleeding from the appendix, considered a rare case of lower gastrointestinal bleeding, is not easily recognized by various diagnostic modalities. A multidisciplinary approach for both a diagnosis and a differential diagnosis is important because the identification of the bleeding site is crucial to proceed to a proper intervention and there are various causes of appendiceal bleeding. Because early colonoscopy plays an important role in the diagnosis and management of lower gastrointestinal hemorrhage, we report a case of a life threatening massive rectal bleeding from the appendix diagnosed by colonoscopy. We also present a review of the literature.

No MeSH data available.


Related in: MedlinePlus

Microscopic examination of the resected appendix revealing a large number of erythrocytes and background erosive lesions in the mucosal layer and surrounding inflammatory infiltrates on the left side (H&E stain, ×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3140672&req=5

Figure 3: Microscopic examination of the resected appendix revealing a large number of erythrocytes and background erosive lesions in the mucosal layer and surrounding inflammatory infiltrates on the left side (H&E stain, ×200).

Mentions: We describe a 33-year-old man who presented a painless massive amount of bright reddish and burgundy rectal bleeding for 3 consecutive days. The patient had neither fever nor abdominal pain. He denied previous digestive tract related medical history as well as taking any of current medicine history, like nonsteroid anti-inflammatory drug. On admission the patient had an acute ill looking appearance and no altered mental status. Resting tachycardia was observed, but his blood pressure was in a normal range. In the second day of admission, he was referred to the endoscopic center where we gauzed the systolic blood pressure just less than 100 mm Hg and he complained dizziness. There were no other specific abnormalities, such as abnormal bowel sound, tender abdomen, or hepatosplenomegaly. The initial hemoglobin level was 12.3 g/dL which subsequently dropped to 9.9 g/dL the next day. Other laboratory exams, like hematologic profiles, were within normal range. The patient was first resuscitated with intravenous saline solution and followed by digestive endoscopies accordingly. An emergency esophagogastroduodenoscopy did not claim any specific lesion, but the colonoscopy disclosed fresh blood at the appendiceal orifice (Fig. 1). Interestingly, after we performed a large amount of water irrigation and removed blood contained liquids, we could not see any fresh blood, implying that the bleeding source did not seem to be around the cecum. Further, following ileoscopy illustrated that the terminal ileum was not evident for any current bleeding episode from the upper level of the tract. However, getting back to the cecum, as the scope entered the appendiceal orifice and after irrigating a small amount of water, it allowed us to corroborate appendiceal intraluminal bleeding in real-time image (Fig. 2). An emergency appendectomy eliminated the bleeding source successfully. On surgery, the appendix, about 8 cm long, had grossly normal appearance except much blood filled in. An eroded focal mucosal lesion was observed at the distal portion of inner part of the vermiform appendix. The histopathological examination revealed a case of appendiceal mucosal erosion (Fig. 3). Although relatively rare, benign appendiceal lesions, such as ulcer or erosion, should be considered a possible cause in patient who present with LGIB. Colonoscopy could reveal the location as well as the characteristics of the affected lesions, whether it provides clinicians with any suspicious source that bleeding takes place.


Massive lower gastrointestinal bleeding from the appendix.

Chung KS, Gao JP - Gut Liver (2011)

Microscopic examination of the resected appendix revealing a large number of erythrocytes and background erosive lesions in the mucosal layer and surrounding inflammatory infiltrates on the left side (H&E stain, ×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3140672&req=5

Figure 3: Microscopic examination of the resected appendix revealing a large number of erythrocytes and background erosive lesions in the mucosal layer and surrounding inflammatory infiltrates on the left side (H&E stain, ×200).
Mentions: We describe a 33-year-old man who presented a painless massive amount of bright reddish and burgundy rectal bleeding for 3 consecutive days. The patient had neither fever nor abdominal pain. He denied previous digestive tract related medical history as well as taking any of current medicine history, like nonsteroid anti-inflammatory drug. On admission the patient had an acute ill looking appearance and no altered mental status. Resting tachycardia was observed, but his blood pressure was in a normal range. In the second day of admission, he was referred to the endoscopic center where we gauzed the systolic blood pressure just less than 100 mm Hg and he complained dizziness. There were no other specific abnormalities, such as abnormal bowel sound, tender abdomen, or hepatosplenomegaly. The initial hemoglobin level was 12.3 g/dL which subsequently dropped to 9.9 g/dL the next day. Other laboratory exams, like hematologic profiles, were within normal range. The patient was first resuscitated with intravenous saline solution and followed by digestive endoscopies accordingly. An emergency esophagogastroduodenoscopy did not claim any specific lesion, but the colonoscopy disclosed fresh blood at the appendiceal orifice (Fig. 1). Interestingly, after we performed a large amount of water irrigation and removed blood contained liquids, we could not see any fresh blood, implying that the bleeding source did not seem to be around the cecum. Further, following ileoscopy illustrated that the terminal ileum was not evident for any current bleeding episode from the upper level of the tract. However, getting back to the cecum, as the scope entered the appendiceal orifice and after irrigating a small amount of water, it allowed us to corroborate appendiceal intraluminal bleeding in real-time image (Fig. 2). An emergency appendectomy eliminated the bleeding source successfully. On surgery, the appendix, about 8 cm long, had grossly normal appearance except much blood filled in. An eroded focal mucosal lesion was observed at the distal portion of inner part of the vermiform appendix. The histopathological examination revealed a case of appendiceal mucosal erosion (Fig. 3). Although relatively rare, benign appendiceal lesions, such as ulcer or erosion, should be considered a possible cause in patient who present with LGIB. Colonoscopy could reveal the location as well as the characteristics of the affected lesions, whether it provides clinicians with any suspicious source that bleeding takes place.

Bottom Line: Massive rectal bleeding from the appendix, considered a rare case of lower gastrointestinal bleeding, is not easily recognized by various diagnostic modalities.A multidisciplinary approach for both a diagnosis and a differential diagnosis is important because the identification of the bleeding site is crucial to proceed to a proper intervention and there are various causes of appendiceal bleeding.We also present a review of the literature.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, The Affiliated YanAn Hospital of Kunming Medical College, Kunming, Yunnan, China.

ABSTRACT
Massive rectal bleeding from the appendix, considered a rare case of lower gastrointestinal bleeding, is not easily recognized by various diagnostic modalities. A multidisciplinary approach for both a diagnosis and a differential diagnosis is important because the identification of the bleeding site is crucial to proceed to a proper intervention and there are various causes of appendiceal bleeding. Because early colonoscopy plays an important role in the diagnosis and management of lower gastrointestinal hemorrhage, we report a case of a life threatening massive rectal bleeding from the appendix diagnosed by colonoscopy. We also present a review of the literature.

No MeSH data available.


Related in: MedlinePlus