Cholangioscope-assisted endoscopic retrograde appendicitis therapy for the diagnosis and treatment of occult appendicitis with a giant fecalith
Year: 2025
Type: article
Study design: Case Report
Abstract: As a main cause of appendicitis, fecaliths have been identified in approximately 40% of patients with acute appendicitis [ 11 ]. Appendicoliths are usually less than 1 cm in their largest dimension, and those that are larger than 2 cm are termed giant appendicoliths [ 22 ]. The most common imaging modalities used to diagnose appendicitis are ultrasound and computed tomography (CT). Because its lumen is long and thin, the appendix can vary greatly, and therefore the basic reliance on ultrasound and CT is not always sufficient to make a reliable diagnosis of appendicitis [ 33 ]. Currently, the diagnosis of appendicitis remains challenging. Herein, we report a rare case of a pediatric patient with occult appendicitis. By means of cholangioscope-assisted endoscopic retrograde appendicitis therapy (ERAT), a giant appendicolith was discovered and flushed out of the appendiceal cavity. A 13-year-old boy was admitted to our hospital with a 2-day history of right lower abdominal pain. Both ultrasound ([ Fig. 1Fig. 1 ] a ) and low-dose CT ([ Fig. 1Fig. 1 ] b ) revealed his appendix was normal. As he had persistent lower right abdominal pain, colonoscopy and cholangioscope-assisted ERAT were (with written parental consent) performed ([ Video 1Video 1 ]). Colonoscopy revealed the appendiceal orifice was normal ([ Fig. 2Fig. 2 ] a ). A cholangioscope was used to intubate the appendiceal cavity, and purulent fluid rapidly flowed out ([ Fig. 2Fig. 2 ] b ). With a clear direct view through the cholangioscope, an appendicolith measuring approximately 2.5 cm in size was discovered in the appendiceal cavity ([ Fig. 3Fig. 3 ] a ); the intraluminal mucosa was congested and edematous with white pus adhesions ([ Fig. 3Fig. 3 ] b ). The appendix was adequately irrigated with normal saline, and the appendicolith was successfully expelled from the cavity ([ Fig. 4Fig. 4 ]). The patient reported his abdominal pain to be relieved after the cholangioscope-assisted ERAT. Fig. 1 Fig. 1 Imaging studies showed the appendix was normal: a ultrasound; b low-dose CT. Fig. 2 Fig. 2 a Colonoscopy revealed a normal appendiceal orifice. b On cholangioscope intubation, purulent fluid flowed out of the appendiceal cavity. Fig. 3 Fig. 3 Cholangioscopic views. a A giant appendicolith, approximately 2.5 cm in size (the thin white scale bars on the cholangioscope indicate 1 cm); b congested and edematous intraluminal mucosa. Fig. 4 Fig. 4 The appendicolith was successfully expelled from the cavity. Download Video Cholangioscope-assisted endoscopic retrograde appendicitis therapy used to diagnose and treat occult appendicitis with a giant fecalith.Video 1Video 1 Endoscopy_UCTN_Code_TTT_1AQ_2AH Endoscopy E-Videos https://eref.thieme.de/e-videos E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos . Publication History Article published online: 05 February 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Source: Endoscopy
DOI: 10.1055/a-2514-2643
Institution: Jishou University
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4407165413