Appendiceal Dieulafoy's Lesion: A Rare Cause of Lower Gastrointestinal Bleeding

Acute lower gastrointestinal bleeding is common in clinical practice. However, it is rarely caused by the appendix, and cases caused by a Dieulafoy's lesion are even more uncommon.

A 39-year-old man presented to a previous hospital with sudden onset of hematochezia. He underwent emergency lower gastrointestinal endoscopy, which revealed bleeding from the appendiceal orifice. Appendiceal bleeding was suspected, and the patient was referred to our department for surgical management. Contrast-enhanced CT performed at our hospital showed an enlarged appendix and a high-density area in the lumen. In conjunction with the colonoscopy findings, he was diagnosed with appendiceal bleeding and underwent an emergency appendectomy. Histopathological examination revealed a shallow ulcer with a torn mucosal fascia; however, most of the submucosal layer remained intact. Capillaries were observed near the disrupted mucosal fascia. The pathological diagnosis was appendiceal bleeding due to Dieulafoy's lesion. The postoperative course was uneventful, and the patient was discharged on POD 4.

Symptomatic appendiceal hemorrhage with massive bleeding should be considered for emergency surgical intervention, given the possibility of bleeding due to a Dieulafoy's lesion.