Korean J Gastroenterol.  2021 Aug;78(2):134-137. 10.4166/kjg.2021.063.

Acute Eosinophilic Appendicitis: A Rare Cause of Lower Gastrointestinal Hemorrhage

• Ahn SR
• Lee JH

• KMID: 2519382
• DOI: http://doi.org/10.4166/kjg.2021.063

Abstract

Acute eosinophilic appendicitis (AEA) is defined as eosinophilic infiltration of the muscular layer of the appendix instead of neutrophils. The symptoms of this disease are similar to those of acute suppurative appendicitis. On the other hand, it can present as a lower gastrointestinal hemorrhage. This paper reports a case of an elderly man with an appendiceal hemorrhage due to AEA. The diagnosis was made by colonoscopy during an evaluation of hematochezia. The patient underwent a laparoscopic partial cecectomy. The histology findings revealed ulceration and marked eosinophilic infiltration of the muscularis propria of the appendix with accompanying edema. Although appendiceal hemorrhage due to AEA is extremely rare, clinicians should consider it in a differential diagnosis.

Keyword

Appendicitis; Eosinophils; Gastrointestinal hemorrhage

Figure

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  Fig. 1 Colonoscopy finding of arterial pulsatile bleeding at the appendiceal orifice.

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  Fig. 2 Gross finding of ulceration (red arrows) 1.5 cm distal from the appendiceal orifice.

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  Fig. 3 Histological findings of (A) central ulcerative lesion (red arrows) (H&E, ×40). (B) Marked eosinophilic infiltration in the muscular layer in the appendix and accompanying edema (H&E, ×100).

Reference

1. Aravindan KP, Vijayaraghavan D, Manipadam MT. 2010; Acute eosinophilic appendicitis and the significance of eosinophil - edema lesion. Indian J Pathol Microbiol. 53:258–261. DOI: 10.4103/0377-4929.64343. PMID: 20551528.

2. Kim DH, Lee JH, Kim D, Hwang S, Kang K, Koo JS. 2019; Acute suppurative appendicitis diagnosed by acute lower gastrointestinal hemorrhage. Korean J Gastroenterol. 73:45–49. DOI: 10.4166/kjg.2019.73.1.45. PMID: 30690958.

3. Choi JM, Lee SH, Lee SH, Ahn BK, Baek SU. 2016; Hematochezia due to angiodysplasia of the appendix. Ann Coloproctol. 32:117–119. DOI: 10.3393/ac.2016.32.3.117. PMID: 27437394. PMCID: PMC4942527.

4. Chiang CC, Tu CW, Liao CS, Shieh MC, Sung TC. 2011; Appendiceal hemorrhage -- an uncommon cause of lower gastrointestinal bleeding. J Chin Med Assoc. 74:277–279. DOI: 10.1016/j.jcma.2011.04.009. PMID: 21621173.

5. Felemban BA, Jastaniah S, Fatani NH, Khan SA, Hassan AA. 2017; Acute eosinophilic appendicitis presenting by lower gastro-intestinal bleeding. Int J Adv Res. 5:1327–1332. DOI: 10.21474/IJAR01/3641.

6. Stephenson J, Snoddy WT. 1961; Appendiceal lesions. Observation in 4,000 appendectomies. Arch Surg. 83:661–666. DOI: 10.1001/archsurg.1961.01300170017005. PMID: 13916928.

7. Carr NJ. 2000; The pathology of acute appendicitis. Ann Diagn Pathol. 4:46–58. DOI: 10.1016/S1092-9134(00)90011-X. PMID: 10684382.

8. Jona JZ, Belin RP, Burke JA. 1976; Eosinophilic infiltration of the gastrointestinal tract in children. Am J Dis Child. 130:1136–1139. DOI: 10.1001/archpedi.1976.02120110098015. PMID: 973619.

9. Jain G, Kanetkar SR. 2013; Case report eosinophilic appendicitis: case report of five cases & review of literature. J Med Res Pract. 2:208–211.

10. Shrestha R, Shrestha A, Tiwari M, Ranabhat S, Maharjan S. 2015; Role of eosinophils in acute appendicitis. JNMA J Nepal Med Assoc. 53:12–17. DOI: 10.31729/jnma.2697. PMID: 26983041.

11. Pineton de Chambrun G, Desreumaux P, Cortot A. 2015; Eosinophilic enteritis. Dig Dis. 33:183–189. DOI: 10.1159/000369540. PMID: 25925921.

12. Aravindan KP. 1997; Eosinophils in acute appendicitis: possible significance. Indian J Pathol Microbiol. 40:491–498. PMID: 9444860.

13. Chung KS, Gao JP. 2011; Massive lower gastrointestinal bleeding from the appendix. Gut Liver. 5:234–237. DOI: 10.5009/gnl.2011.5.2.234. PMID: 21814607. PMCID: PMC3140672.

14. Chung IH, Kim KH. 2011; A case of successful colonoscopic treatment of acute appendiceal bleeding by endoclips. J Korean Soc Coloproctol. 27:329–332. DOI: 10.3393/jksc.2011.27.6.329. PMID: 22259749. PMCID: PMC3259430.

15. Kyokane T, Akita Y, Katayama M, et al. 2001; Angiodysplasia of the appendix. Am J Gastroenterol. 96:242–244. DOI: 10.1111/j.1572-0241.2001.03385.x. PMID: 11197261.