When the cure turns cold: ischaemic appendicitis as a rare complication of ileocolic embolization

TL;DR

A rare case of appendicitis following a blood vessel blockage procedure in the gut is reported, highlighting the need for careful monitoring.

Contribution

This paper presents an extremely rare case of ischaemic appendicitis following ileocolic embolization, previously only described once.

Findings

Acute perforated appendicitis occurred after ileocolic angioembolization for colonic bleeding.

Ischemic complications from embolization in the ileocolic region are rare but require close monitoring.

Non-operative management was successful in this case, suggesting potential for conservative treatment.

Abstract

In many tertiary centers with rapid access and expertise, IR angioembolization is now frequently employed as first line treatment for control of active and potentially life-threatening hemorrhage, rather than endoscopic or surgical management. We present an extremely rare case of acute perforated appendicitis following ileocolic angioembolization, for the management of major colonic bleeding. Although acute appendicitis is a very common general surgical pathology, its occurrence secondary to angioembolization, representing an ischemic complication, has only been described once before in the literature. It is thus important to maintain close clinical observation for signs of ischemia following gastrointestinal embolization procedures, particularly when performed in the ileocolic region due to its limited collateral blood supply. While non-operative management was successfully pursued, as more cases are published in the literature, a consensus guideline can ideally be developed to determine the optimal management for this rare subset of patients.

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