Spontaneous expulsion of a huge appendiceal fecalith after endoscopic treatment
Fan Wang, Hongling Wang, Sikai Chen, Qiu Zhao, Jiali Hu
Abstract
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TopicsGastrointestinal disorders and treatments · Diverticular Disease and Complications · Esophageal and GI Pathology
A 38-year-old woman was admitted due to intermittent right lower abdominal pain experienced for half a year. At the local hospital, abdominal computed tomography (CT) scan showed a huge appendiceal fecalith (1.35 × 0.81 cm) ( Fig. 1 ). After admission, abdominal ultrasonography confirmed the appendiceal fecalith (1.49 × 0.58 cm; 3.3 cm from the orifice; appendix size 6.7 × 0.7 cm, retroileal location; diameter 0.8 cm; wall thickness 0.12 cm). Endoscopic retrograde appendicitis therapy using an appendoscope (eyeMAX, 9-French; Micro-Tech [Nanjing] Co., Ltd., China) was planned 1 .
A huge appendiceal fecalith was detected on imaging. a Computed tomography (CT) scan half a year before endoscopic treatment. b Repeat CT scan before endoscopic treatment. c Ultrasonography before endoscopic treatment.
During the operation, the appendoscope was inserted into the appendiceal lumen, and the mucosa was smooth ( Fig. 2 , Video 1 ). Lumen stenosis was detected, and a guidewire was used for exploration before dilating the stenosis repeatedly with the appendoscope body. The fecalith was found at the end of the appendix but could not be grasped with a basket (diameter 1.0 cm). Finally, a plastic stent (8.5 Fr × 5 cm) was implanted into the appendix from the ileocecum.
Endoscopic treatment of the appendiceal fecalith. The appendoscope was passed through the appendiceal orifice and stenosis with the help of a guidewire. The fecalith was detected but could not be grasped with a basket. A plastic stent was placed.
Spontaneous expulsion of a huge appendiceal fecalith after endoscopic treatment.Video 1
Right lower abdominal pain was noted during the following 3 days. On the 4th day, the patient’s pain was significantly relieved, and simultaneous CT scan showed expulsion of the appendiceal fecalith into the sigmoid colon ( Fig. 3 ). On the 11th day, the stent was expelled with the stool. To the best of our knowledge, this is the first reported spontaneous expulsion of a huge appendiceal fecalith after endoscopic treatment.
Imaging after endoscopic treatment. a Ultrasonography detected the fecalith (1.57 × 0.64 cm) and stent (arrow) 2 days after endoscopic treatment. b Computed tomography scan detected the stent end around the appendiceal orifice and fecalith expulsion into the sigmoid colon (size 1.46 × 0.86 cm) 4 days after endoscopic treatment.
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