Appendiceal hemorrhage

Case contributed by Dr James Harvey

Presentation

A woman presented hypotensive to the emergency department with haematochaezia. An estimated further 2L of blood loss was recorded in ED.

Patient Data

Age: 60-70
Gender: Female

Bleeding study

CT

A contrast blush is seen within the mid-appendiceal lumen on the arterial phase CT. The blush expands on delayed phase imaging and layering blood is seen within the cecum.
There is no peri-appendiceal fat stranding or distension of the appendix to suggest appendicitis and no focal thickening of the appendix to indicate an underlying lesion.

Annotated CT

CT

Focused images of the appendix which demonstrates hyperdensity representing the contrast blush within the appendiceal lumen. Dependent blood is seen within the cecum.

The patient was referred to general surgery. The bleeding stopped and the patient remained haemodynamically stable. A colonoscopy was arranged.

Case Discussion

Appendiceal hemorrhage is a very rare cause of lower gastrointestinal bleeding.
Causes include benign erosions into the appendiceal artery, ulcers, carcinoid tumors, lymphoma or angiodysplasia.

The cause for hemorrhage in this case is not known.

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