An unusual cause of lower gastrointestinal bleeding (original) (raw)

Appendiceal bleeding, a rare yet important cause of lower gastrointestinal bleed

2024

Background: Lower gastrointestinal bleeding accounts for 20 to 25% of all gastrointestinal bleedings. Appendiceal bleeding is a rare, yet important cause of lower gastrointestinal bleed; in many cases, it can be misdiagnosed as obscure gastrointestinal bleeding. Here, we present a case of appendiceal bleeding in an elderly female. Case description: A 79-year-old female presented with acute onset of gastrointestinal bleeding of same-day duration. Investigations showed that she had an appendiceal bleed originating from an ulcer secondary to a small appendicolith, which has passed through the appendiceal orifice, combined with her aspirin use. Within 12 hours, a laparoscopic appendectomy was performed. No evidence of malignancy or vascular malformation was detected, and the post-operative course was smooth, with resultant discharge at day 3 after her surgery. Discussion: For lower gastrointestinal bleeding, it is crucial for the endoscopist to reach the terminal ileum during the colonoscopy, and thoroughly inspect the orifice of the appendix to assess any source of bleed including but not limited to Dieulafoy's lesion, angiodysplasia or any vascular malformation. An effective treatment option for appendiceal bleeding is surgical management with appendectomy. Alternative approaches such as vessel embolization and endoscopic treatment have been reported to successfully control bleeding; nevertheless, the risk of acute appendicitis and recurrent bleeding following these procedures can be challenging to manage, potentially leading the patient to still need a surgical treatment with an appendectomy.

Acute lower intestinal bleedingPart II: Etiology, therapy, and outcomes

Gastrointestinal Endoscopy, 1999

Angiodysplasias are ectatic blood vessels seen in the mucosa and submucosa of the GI tract, with a 1% to 2% incidence in the colon at autopsy and Level I: Definitive diagnosis A: Actively bleeding lesion found at endoscopy (anoscopy, sigmoidoscopy, or colonoscopy) or angiography B: Stigmata of recent bleeding (nonbleeding visible vessel, adherent clot) found at endoscopy C: Positive tagged red blood cell (TRBC) scan if verified by IA or IB Level II: Presumptive diagnosis/circumstantial evidence A: Fresh blood localized to colon segment inhabited by potential bleeding source B: Positive TRBC scan localizing to the colon and colonoscopy that shows potential bleeding site in area of positive scan C: Bright red blood per rectum confirmed by objective color testing and colonoscopy that demonstrates single potential bleeding source in colon, complemented by negative upper endoscopy Level III: Equivocal diagnosis A: "Hematochezia" or blood per rectum (without color specification) and colonoscopy that demonstrates 1 or more potential bleeding sources *Presurgical evaluation.

An unusual cause of lower gastrointestinal haemorrhage

BMJ case reports, 2011

A previously unreported cause of lower gastrointestinal haemorrhage in a 63-year-old female patient on clopidogrel for cardiac comorbidities is presented. Endoscopy suggested a small bowel or colonic aetiology but failed to accurately localise the source. The patient became haemodynamically unstable despite conservative management and temporary cessation of clopidogrel. CT angiography demonstrated a pseudoaneurysm arising from the superior rectal artery. Percutaneous embolisation using coils was performed to successfully occlude the pseudoaneurysm, prevent further haemorrhage and avoid emergency colonic resection.

Investigative modalities for massive lower gastrointestinal bleeding

World Journal of Surgery, 2002

The objective of this study was to evaluate the efficacy of various diagnostic modalities in the assessment of patients with massive lower gastrointestinal bleeding. The charts of all patients admitted to a McGill University affiliated teaching hospital with the diagnosis of lower gastrointestinal bleeding over a 25-year period were reviewed. There were 136 patients who underwent 202 admissions. The information documented included demographics on age, gender, co-morbid disease, prescribed medications, requirements for blood transfusions, orthostatic change in blood pressure, acute drop in hematocrit (to < 30%), and exclusion of upper gastrointestinal bleeding. Among the 202 admitted patients there were 116 men and 86 women), with an average age of 70 years (range 16-95 years). At least one significant medical disease was found in 93% of these patients; and 20% were on aspirin and 5% on anticoagulants at the time of diagnosis. Rigid or flexible sigmoidoscopy was performed in 68 and 18 patients, respectively, with a definitive diagnosis made in 2.9% and 11.0%, respectively. Colonoscopy was performed in 152 cases, 20 of which were incomplete; a specific diagnosis was made for 59 admissions (45%). A red blood cell or colloid scan was performed on 53 patients, with extravasation noted in 13 (24.5%); a localized site of bleeding was identified in 9 cases (17%). Angiography was performed on 31 patients with bleeding sites localized in 6 (19%). Barium enemas were completed in 85 of 92 patients, and the presumptive cause of bleeding was identified in 72% of those with a complete examination. The most common causes identified were diverticulosis in 52 patients and angiodysplasia in 14. The cause of bleeding was not detected in 48 (35%). Bleeding stopped in most patients spontaneously, with only 7 requiring operation. The average number of units transfused was 3 (range 0-26). Scintigraphy and angiography were less efficacious than colonoscopy for localizing the site and etiology of the bleeding. Despite the combination of investigative modalities, a definitive diagnosis was not made in 35% of the admitted patients. The need for operative intervention in our study was lower than in most previous reports.

Diagnostic and therapeutic approaches to bleeding from lower parts of the digestive system

Acta chirurgica Iugoslavica, 2008

Bleeding from the gastrointestinal tract represents a relatively common diagnostic and therapeutic challenge in clinical work of gastroenterologists and surgeons. Bleeding from the lower GI (LGIB) is mostly caused by pathologic conditions of the colon, although the source of bleeding cannot always be exactly localized, thus rendering optimal and prompt therapy difficult. During two year period, at III department of the First Surgical Clinic in Belgrade, we performed 424 colonoscopies for LGIB. According to our results the exact diagnosis was established in about 76% (324 patients) showing a great similarity with the results of other published studies (varying between 74% and 89%). The most common causes of bleeding were diverticulosis (37.11%), polyposis (10.3%) and colorectal cancer (46.14%). Besides that we have mentioned some specific facts involving the diagnosis and treatment of LGIB with an accent on some rare conditions, like angiodysplasia. Review of the diagnostic procedure...

An unusual multiplex cause of severe gastrointestinal bleeding in a haemodialysed patient

Nephrology Dialysis Transplantation, 2000

failure; gastro-drug treatment. She required a total of 29 units of packed red blood cells over a 4-month period. The intestinal bleeding; oestrogen-progesterone therapy; vascular malformation; watermelon stomach investigations excluded any coagulation abnormalities, haematological and gynecological diseases. Although there was no evidence of manifest bleeding, the patient's stool was consistently positive for occult