Endoscopic diagnosis of appendiceal hemorrhage with a disposable imaging catheter (EyeMax): a case report

Appendiceal hemorrhage is an extremely rare cause of lower gastrointestinal bleeding, often lacking specific clinical manifestations and therefore easily missed. Due to the anatomical location of the appendix, conventional colonoscopy often fails to visualize the appendiceal lumen directly, making diagnosis challenging.

A 53-year-old male was admitted with sudden onset of hematochezia. Emergency colonoscopy revealed blood throughout the colon without an identifiable bleeding source. Contrast-enhanced abdominal CT scan showed an enlarged appendix measuring approximately 10 mm in diameter, without signs of acute inflammation. As bleeding recurred the next day, a second colonoscopy was performed. A diverticulum in the cecum was suspected as the source and was clipped. However, while adjusting the scope, active bleeding was observed from the appendiceal orifice. In response, a disposable imaging catheter (EyeMax) was immediately advanced into the appendiceal lumen. The proximal lumen appeared clean, but deeper segments showed blood clots and ongoing bleeding, confirming appendiceal hemorrhage. The patient subsequently underwent laparoscopic appendectomy. Intraoperatively, the appendiceal lumen was filled with clots and active bleeding was observed. Gross examination of the specimen revealed a mucosal ulcer. Histopathology showed chronic appendicitis. The patient recovered well postoperatively, no further bleeding occurred during 6-month follow-up.

The use of disposable imaging catheters enables direct endoscopic visualization of appendiceal intraluminal pathology, thereby improving diagnostic precision in challenging appendiceal cases. This minimally invasive technique shows promising clinical utility and may serve as a valuable adjunct in the diagnostic algorithm of rare appendiceal bleeding disorders.

This case demonstrates the utility of a disposable imaging catheter in identifying active appendiceal bleeding, which is often missed by conventional endoscopy. The technique offers a novel diagnostic option for this rare but important condition.