{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T03:05:04Z","timestamp":1780628704790,"version":"3.54.1"},"reference-count":13,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,11,18]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:p>The case report discusses the challenges in diagnosing gastrointestinal bleeding of unknown origin, with angiodysplasia (AD) of the appendix being a rare cause. The report presents a case of a man in his late 60s who presented with vomiting, diarrhoea and rectal bleeding. As a result of the bleeding, the patient developed a type II myocardial infarction (MI), which had to be simultaneously managed further complicating the diagnostic process. Despite a normal CT angiogram, ongoing bleeding led to suspicion of AD, which was diagnosed using colonoscopy with limited bowel preparation. The patient underwent an open appendicectomy and was found to have AD of the tip of the appendix as the cause of the bleeding. The case highlights the limitations of CT angiography in haemodynamically unstable patients and subsequent importance of colonoscopy with bowel preparation in diagnosing rare causes of bleeding, even with limited bowel preparation, and the potential life-threatening consequences of untreated AD.<\/jats:p>","DOI":"10.1136\/bcr-2023-255498","type":"journal-article","created":{"date-parts":[[2023,12,12]],"date-time":"2023-12-12T12:41:42Z","timestamp":1702384902000},"page":"e255498","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Angiodysplasia of the appendix: a diagnostic challenge and the importance of colonoscopy"],"prefix":"10.1136","volume":"16","author":[{"given":"Obiajulu","family":"Johnson","sequence":"first","affiliation":[{"name":"Royal Albert Edward Infirmary, Wigan, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Mackenzie","sequence":"additional","affiliation":[{"name":"Royal Albert Edward Infirmary, Wigan, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamil","family":"Choudhury","sequence":"additional","affiliation":[{"name":"Wrightington Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Furtado","sequence":"additional","affiliation":[{"name":"Wrightington Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,12,12]]},"reference":[{"key":"2025082712575170000_16.12.e255498.1","first-page":"807","article-title":"Angiodysplasia of the gastrointestinal tract","volume":"88","author":"Foutch","year":"1993","journal-title":"Am J Gastroenterol"},{"key":"2025082712575170000_16.12.e255498.2","article-title":"Prevalence of Angiodysplasia detected in upper gastrointestinal endoscopic examinations","volume":"13","author":"Notsu","year":"2021","journal-title":"Cureus"},{"key":"2025082712575170000_16.12.e255498.3","doi-asserted-by":"crossref","first-page":"e110","DOI":"10.1097\/SLE.0b013e3181ba83de","article-title":"Acute lower gastrointestinal bleeding due to Appendiceal Mucosal erosion","volume":"20","author":"Baek","year":"2010","journal-title":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques"},{"key":"2025082712575170000_16.12.e255498.4","doi-asserted-by":"crossref","first-page":"e334","DOI":"10.1177\/000313481508100906","article-title":"An unusual case of metastatic basal cell carcinoma from the upper extremity","volume":"81","author":"Reynolds","year":"2015","journal-title":"Am Surg"},{"key":"2025082712575170000_16.12.e255498.5","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.jcma.2011.04.009","article-title":"Appendiceal hemorrhage - an uncommon cause of lower gastrointestinal bleeding","volume":"74","author":"Chiang","year":"2011","journal-title":"J Chin Med Assoc"},{"key":"2025082712575170000_16.12.e255498.6","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s40792-021-01234-3","article-title":"Appendiceal bleeding in an elderly male: a case report and a review of the literature","volume":"7","author":"Maeda","year":"2021","journal-title":"Surg Case Rep"},{"key":"2025082712575170000_16.12.e255498.7","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Compe\u00e1n D et al . Diagnostic and therapeutic challenges of gastrointestinal Angiodysplasias: A critical review and view points, world Journal of Gastroenterology. 2019. Available: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6558444 [Accessed 23 Oct 2023].","DOI":"10.3748\/wjg.v25.i21.2549"},{"key":"2025082712575170000_16.12.e255498.8","first-page":"12","article-title":"Gastrointestinal Angiodysplasia as a cause of hemorrhage in the digestive tract and treatment","volume":"133","author":"Zamir","year":"1997","journal-title":"Harefuah"},{"key":"2025082712575170000_16.12.e255498.9","doi-asserted-by":"crossref","unstructured":"Choi J-M et al . Hematochezia due to Angiodysplasia of the Appendix, annals of Coloproctology. 2016. Available: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4942527","DOI":"10.3393\/ac.2016.32.3.117"},{"key":"2025082712575170000_16.12.e255498.10","unstructured":"Aoki T et al . Initial management for acute lower gastrointestinal bleeding, world Journal of Gastroenterology. 2019. 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