Tang BX, Li XD, Li XL. Lower gastrointestinal bleeding attributed to xanthogranulomatous appendicitis: A case report. World J Gastrointest Endosc 2026; 18(6): 122027 [DOI: 10.4253/wjge.v18.i6.122027]
Corresponding Author of This Article
Xin-Li Li, Associate Professor, Laboratory Section, Zibo Central Hospital, No. 54 Gongqingtuan Road, Zibo 255000, Shandong Province, China. lixinli82@163.com
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Gastroenterology & Hepatology
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case-report
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Tang BX, Li XD, Li XL. Lower gastrointestinal bleeding attributed to xanthogranulomatous appendicitis: A case report. World J Gastrointest Endosc 2026; 18(6): 122027 [DOI: 10.4253/wjge.v18.i6.122027]
World J Gastrointest Endosc. Jun 16, 2026; 18(6): 122027 Published online Jun 16, 2026. doi: 10.4253/wjge.v18.i6.122027
Lower gastrointestinal bleeding attributed to xanthogranulomatous appendicitis: A case report
Bing-Xi Tang, Xiao-Dong Li, Xin-Li Li
Bing-Xi Tang, Xiao-Dong Li, Department of Gastroenterology, Zibo Central Hospital, Zibo 255000, Shandong Province, China
Xin-Li Li, Laboratory Section, Zibo Central Hospital, Zibo 255000, Shandong Province, China
Author contributions: Tang BX performed the colonoscopy and drafted the manuscript; Li XL designed the research; Li XD helped collect the medical data; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Received: April 8, 2026 Revised: April 27, 2026 Accepted: May 20, 2026 Published online: June 16, 2026 Processing time: 63 Days and 22.3 Hours
Abstract
BACKGROUND
Acute appendicitis is an infrequent etiology of lower gastrointestinal bleeding (LGIB), with approximately 20 reported cases globally. To the best of our knowledge, xanthogranulomatous appendicitis (XGA) presenting with LGIB has not been described in the literature.
CASE SUMMARY
The patient was a 41-year-old man admitted for blood in stool for 1 day. He had previously been healthy. One month ago, the patient underwent a routine health check-up, which revealed a hemoglobin (HGB) level of 145 g/L. Following hematochezia, repeat laboratory testing showed a quick decrease in HGB level to 94 g/L. Emergency colonoscopy revealed dark red blood throughout the intestinal lumen, with visible fresh red bleeding emanating from the appendiceal lumen. Bleeding was intermittent. After copious irrigation with normal saline, observation for approximately 3 minutes found persistent fresh red bleeding from the appendiceal lumen, while no blood staining was observed in the terminal ileum. The patient underwent laparoscopic appendectomy, and postoperative pathology suggested XGA with mucosal ulceration and hemorrhage.
Core Tip: Lower gastrointestinal bleeding (LGIB) has diverse etiologies, yet identifying the source remains challenging in approximately 10% of cases. Appendiceal bleeding is a rare condition that often necessitates repeated colonoscopy for diagnosis. Appendicitis is a recognized cause of LGIB, but bleeding due to xanthogranulomatous appendicitis (XGA) has not been reported in the literature. We present possibly the first case of XGA presenting with LGIB, which was diagnosed endoscopically and confirmed surgically.
