Case report: An unusual case of cecal mucosal bleeding

Area of Science:

• Gastroenterology
• Internal Medicine

Background:

• Lower gastrointestinal (GI) bleeding is a common clinical presentation.
• Causes of lower GI bleeding are diverse, but cecal mucosal bleeding is rarely documented.

Observation:

• A 73-year-old woman with end-stage renal disease (ESRD) and atrial fibrillation on apixaban presented with significant lower GI bleeding and anemia.
• Colonoscopy identified active, localized cecal mucosal bleeding as the source, with no other identifiable lesions like Dieulafoy's lesion, ulcers, or vascular malformations.
• The bleeding was successfully controlled endoscopically using epinephrine injection and bipolar electrocautery.

Findings:

• Cecal mucosal bleeding, though rare and intermittent, can cause substantial lower GI hemorrhage.
• Endoscopic hemostasis is an effective treatment modality for this condition.
• Anticoagulation in patients with ESRD increases the risk of GI bleeding.

Implications:

• This case expands the differential diagnosis for acute lower GI bleeding, emphasizing cecal mucosal bleeding.
• Early identification and endoscopic management are crucial for patients presenting with unexplained lower GI bleeding, especially those on anticoagulation.
• Clinicians should consider cecal mucosal bleeding in the differential diagnosis, particularly in patients with risk factors such as ESRD and anticoagulation therapy.