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DOI: 10.1055/a-2433-1332
Mucus plug-induced obstruction in acute appendicitis
Supported by: The Technology Transfer Fund of Zhongnan Hospital of Wuhan University No. 2022CGZH-ZD005
Supported by: Translational Medicine and Interdisciplinary Research Joint Fund of Zhongnan Hospital of Wuhan University No. ZNJC20222
A 53-year-old man was admitted for mid-upper abdominal pain and constipation for three days. The patient had a history of imperforate anus surgery. After admission, barium enema examination indicated localized stenosis of the anal canal and difficult defecation of contrast material. Colonoscopy showed the postoperative annus and appendiceal orifice edema with purulent secretion. With the possibility of appendicitis considered, endoscopic retrograde appendicitis therapy (ERAT) using an appendoscope (eyeMAX, 9-French; Micro-Tech (Nanjing) Co., Ltd., China) was prepared subsequently [1].
During the operation, the appendoscope was inserted into the appendiceal lumen and a long strip of vitrina from the appendix opening to the terminus was detected ([Video 1], [Fig. 1], [Fig. 2]). The vitrina was flushed out by the lavage of 0.5% metronidazole. In addition to mucous hyperemia, no neoplasm was found in the following appendix exploration ([Fig. 3]). The patient’s abdominal pain was relieved immediately after the procedure. Finally, the vitrina was pathologically confirmed to be denatured necrosis ([Fig. 4]). The patient was discharged three days later, and no recurrence or any other adverse event was noted during a two-month follow-up. To the best of our knowledge, this is the first reported endoscopic diagnosis and treatment of mucus plug-induced obstruction in acute appendicitis.
Endoscopic diagnosis and treatment of mucus plug-induced obstruction in acute appendicitis.Video 1
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Conflict of Interest
The authors declare that they have no conflict of interest.
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Reference
- 1 Wang F, Zhu Y, Zhao Q. et al. Multifocal stenosis in purulent appendicitis with fecalith. Endoscopy 2024; 56: E108-E109
Correspondence
Publication History
Article published online:
25 October 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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Reference
- 1 Wang F, Zhu Y, Zhao Q. et al. Multifocal stenosis in purulent appendicitis with fecalith. Endoscopy 2024; 56: E108-E109