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

A 43-year-old man with a history of heavy alcohol consumption presented with seven episodes of hematochezia within 8 h (50-100 g each), accompanied by vague upper abdominal discomfort. Initial treatment for suspected acute gastrointestinal bleeding with esomeprazole and somatostatin was ineffective. Two hours after admission, recurrent hematochezia occurred with hemodynamic deterioration, including hypotension, decreased hemoglobin, pallor, tachycardia, and cold extremities. Contrast-enhanced abdominal CT demonstrated contrast extravasation and blood accumulation in the ileocecal region, suggesting bleeding from the appendiceal and ileocecal arteries. Colonoscopy revealed segmental intraluminal blood and persistent bleeding from the appendiceal orifice despite repeated irrigation. Emergency laparoscopic appendectomy was performed. Histopathology showed thick-walled vascular proliferation consistent with an appendiceal Dieulafoy's lesion. The patient recovered uneventfully without recurrent bleeding during a 6-month follow-up. This case highlights the atypical, rapidly progressive nature of appendiceal Dieulafoy's lesion and the diagnostic value of contrast-enhanced CT and timely endoscopy.