S4667 Coil Embolization of Appendiceal Artery Bleed Leading to Appendicitis and Surgical Resection: A Case Report

Introduction: Appendiceal bleeding is an infrequent cause of lower gastrointestinal bleeding (LGIB), accounting for only 0.014% of cases. Etiologies include diverticulitis, angiodysplasia, Dieulafoy’s lesions, neoplasms, and inflammation. Diagnosis is often delayed due to intermittent bleeding and poor endoscopic visibility. Current guidelines recommend that hemodynamically unstable patients with suspected LGIB undergo urgent computed tomography angiography (CTA) to localize the source, followed by endoscopic or radiologic intervention. Transcatheter arterial embolization (TAE) is an effective option in such cases; however, embolizing end-arterial branches, such as the appendiceal artery, carries a theoretical risk of ischemia. Case Description/Methods: We present the case of a 48-year-old man on heparin for suspected acute coronary syndrome who developed acute LGIB. Colonoscopy was inconclusive, and CTA revealed active extravasation from the appendicular branch of the ileocolic artery. The patient underwent successful coil embolization. However, he developed signs of peritonitis the following day. Repeat imaging raised concern for appendicitis, and appendectomy confirmed the diagnosis. He recovered fully without recurrence of bleeding. Discussion: To our knowledge, this is the first reported case of appendicitis following coil embolization of the appendiceal artery. The appendix is uniquely vulnerable to ischemia due to its solitary arterial supply. While TAE offers a potential therapeutic option in managing appendiceal hemorrhage, this case highlights the need for clinicians to remain vigilant for post-embolization appendicitis and the importance of early surgical consultation.