Low gastrointestinal bleeding(LGIB) derived from the appendix is a rare case, and not easily recognized by various diagnostic modalities. Although many diagnostic approaches are provided, the colonoscopy is still considered to be the current preferred diagnostic modality. This case report was about hematochezia from solitary appendiceal intraluminal. Active appendiceal hemorrhage from orifice was identified during the second colonoscopy after subsequent esophagogastroduodenoscopy and capsule endoscopy with negative findings. The patient recovered after laparoscopic appendectomy. The histology revealed a large number of erythrocytes and background vascular proliferation lesions. Finally, we reviewed the relevant literature.