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DOI: 10.1055/a-2333-9599
Appendiceal fecalith misdiagnosed as cecal stromal tumor: don't fall into the trap
Gefördert durch: The Key R&D Program of Henan Province 222102310038
A 30-year-old man presented with a 2-day history of hematochezia and a 4-year history of intermittent abdominal pain. Computed tomography scan revealed a low-density mass with central calcification in the cecum ([Fig. 1] a). Colonoscopy showed a 15×15 mm cecal mass with a superficial ulcer ([Fig. 1] b). A cecal submucosal tumor was considered. The surgeon recommended ileocecectomy or partial cecectomy. The patient was afraid of surgery and was transferred to our department.
We performed a second colonoscopy, which revealed that the mass originated from the appendix opening and the “ulcer” appeared to be fecalith-like substance. We made a diagnosis of appendiceal fecalith, not submucosal tumor. A snare was applied to resect the fecalith. With the appendiceal orifice opened ([Fig. 1] c), a fecalith stump was found in the appendiceal cavity, which confirmed our diagnosis.
Subsequently, endoscopic retrograde appendicitis therapy (ERAT) was performed ([Video 1]). A catheter was inserted into the end of the appendiceal cavity, normal saline was used to flush the cavity, and two large fecaliths were flushed out ([Fig. 1] d). Pathologic examination revealed inflammatory tissue. The patient recovered uneventfully and stayed stable during follow-up.
We demonstrate an interesting case of appendiceal fecaliths mimicking appendiceal tumor, which is likely to be misdiagnosed. We performed a minimally invasive procedure, endoscopic retrograde appendicitis therapy, to deal with it, which avoided traumatic surgery for the patient.Video 1This case suggests that appendiceal fecalith causing mucosal inflammation may be misdiagnosed as cecal submucosal tumor. ERAT has both therapeutic and diagnostic value.
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Conflict of Interest
The authors declare that they have no conflict of interest.
Correspondence
Publikationsverlauf
Artikel online veröffentlicht:
29. Juli 2024
© 2024. 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/).
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