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Korean J Gastroenterol 2019; 73(1): 45-49  https://doi.org/10.4166/kjg.2019.73.1.45
Acute Suppurative Appendicitis Diagnosed by Acute Lower Gastrointestinal Hemorrhage
Dae-ha Kim, Ju Han Lee1, Dongwoo Kim, Suhyun Hwang, Kyuho Kang and Ja Seol Koo
Division of Gastroenterology, Department of Internal Medicine, Department of Pathology1, Korea University Ansan Hospital, Ansan, Korea
Correspondence to: Ja Seol Koo, Division of Gastroenterology, Department of Internal Medicine, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea. Tel: +82-31-412-4853, Fax: +82-31-412-5582, E-mail: jskoo@korea.ac.kr, ORCID: https://orcid.org/0000-0002-1202-075X
Received: March 1, 2018; Revised: June 21, 2015; Accepted: June 24, 2018; Published online: January 25, 2019.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
A 49-year-old man visited the emergency room of Korea University Ansan Hospital with hematochezia starting the day before the visit. Recently, he was on anti-platelet medication due to hypertension. The patient had no definite symptoms other than hematochezia. Digital rectal exam was positive and laboratory tests showed severe anemia. Sigmoidoscopy was initiated and almost no fecal material was observed in the intestinal tract, allowing insertion into the cecum. Active bleeding from the appendiceal opening was noted. On abdominal CT, contrast enhancement was observed at the tip of the appendix. Under suspicion of acute appendicitis, we consulted with a surgeon. The patient underwent appendectomy with partial cecal resection. Pathologic examination revealed a diagnosis of appendix bleeding due to acute suppurative appendicitis. The patient had no further bleeding after surgery and was discharged in a stable state. Careful observation by the endoscopist is necessary for accurate diagnosis of lower gastrointestinal hemorrhage. Appendiceal hemorrhage is very rarely reported, but it has various pathophysiologies. CT scan is useful when appendiceal hemorrhage is confirmed by endoscopic findings. Surgical treatment was needed in almost all cases reported worldwide. If bleeding from the appendix is confirmed, surgical treatment should be considered for both therapeutic and diagnostic purposes.
Keywords: Gastrointestinal hemorrhage; Appendicitis; Appendix; Colonoscopy; Appendectomya

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