A rare case of lower gastrointestinal bleeding from an appendiceal arteriovenous malformation in a Filipino

A Case Report

Abstract

Background: Acute bleeding from the appendix is uncommon with only 32 reported cases in the literature. To our knowledge, this is the first reported case in the Philippines of gastrointestinal bleeding secondary to an arteriovenous malformation of the appendix. This case highlights the importance of including the appendix as a possible source of lower gastrointestinal bleeding.

Case Summary: A 32-year-old male presented with acute painless hematochezia. On urgent colonoscopy, fresh and dark blood with clots filled the entire colon, while the terminal ileum was free from blood which was highly suggestive of a colonic source of bleeding. After a thorough irrigation of the ileocecal region, significant amount of blood was seen oozing intermittently from the appendiceal orifice. An emergency laparoscopic appendectomy was performed. On gross examination, the appendix was enlarged and on cut section, there was a prominent vessel.  Histopathologic examination showed acute appendicitis with serosal congestion and there were thickened and enlarged vessels. Immunohistochemistry was positive for CD31 and CD34, consistent with arteriovenous malformation. 

Conclusion: In cases of suspected colonic bleeding with no obvious cause, appendiceal hemorrhage should be one of the considerations so as not to miss this rare but treatable cause of lower gastrointestinal bleeding.

Keywords: appendix bleeding, appendix hemorrhage, arteriovenous malformation