A 69-year-old man was admitted to our hospital with 1-week history of intermittent
lower abdominal pain. He had a history of subtotal gastrectomy performed 6 years prior
for gastric carcinoma. An abdominal computed tomography scan revealed a localized
high-density area in the appendix ([Fig. 1]). Colonoscopy showed a significantly protruding appendix with an impacted fecalith,
resulting in marked dilation of the appendiceal orifice ([Fig. 2]). This appearance resembled that of impacted stones in the duodenal papilla.
Fig. 1 Abdominal computed tomography scan demonstrating a localized high-density area in
the appendix.
Fig. 2 Endoscopic view of a significantly protruding appendix with an impacted fecalith.
After obtaining informed consent, we performed endoscopic removal of fecalith ([Video 1]). A 1.5-mm Goldknife (Micro-tech, Nanjing, China) was inserted into the appendiceal
lumen, and a full-thickness incision was made from the dilated appendiceal orifice
to the base of the protrusion, without requiring submucosal injection. Then, the fecalith
was fully exposed and extruded into the colonic lumen with the aid of the Goldknife
([Fig. 3]). Following the removal, the appendiceal lumen was irrigated with water, and no
bleeding or perforation was observed. The procedure was completed without immediate
complications, and the incision was left open ([Fig. 4]). The patient was kept fasting for 6 hours after the procedure. His abdominal symptoms
resolved, and no postoperative complications were noted. He was discharged 2 days
after the procedure.
Fig. 3 Endoscopic view of the fecalith after extrusion into the colonic lumen.
Fig. 4 Endoscopic view of the appendiceal incision left open for healing after removal of
the fecalith.
Endoscopic removal of impacted fecalith from the appendix in a 69-year-old man with
1-week history of intermittent lower abdominal pain.Video 1
Appendiceal fecaliths are commonly implicated in acute appendicitis due to their obstructive
potential within the appendiceal lumen. Traditional management typically requires
surgical intervention [1]
[2]. However, in the present case, endoscopic incision was successfully used to facilitate
the removal of an impacted fecalith. Our experience suggests that endoscopic incision
can provide a feasible and less invasive treatment option for patients with impacted
fecaliths, potentially reducing surgical risks and expediting recovery.
Endoscopy_UCTN_Code_TTT_1AQ_2AF
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