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CC BY 4.0 · Endoscopy 2025; 57(S 01): E341-E342
DOI: 10.1055/a-2578-2400
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Spontaneous expulsion of a huge appendiceal fecalith after endoscopic treatment

Fan Wang
1   Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
,
Hongling Wang 
1   Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
,
Sikai Chen
2   Department of Ultrasound, Zhongnan Hospital of Wuhan University, Wuhan, China
,
Qiu Zhao 
1   Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
,
Jiali Hu
3   Department of Pathology, Affiliated Hospital of Jiujiang University, Jiujiang, China
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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].

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Fig. 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.

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Fig. 2 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.

Quality:
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.

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Fig. 3 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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Conflict of Interest

The authors declare that they have no conflict of interest.


Correspondence

Jiali Hu, MD
Department of Pathology, Affiliated Hospital of Jiujiang University
57 Xunyang East Road
Jiujiang 332000
China   

Publication History

Article published online:
29 April 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/).

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Zoom Image
Fig. 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.
Zoom Image
Fig. 2 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.
Zoom Image
Fig. 3 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.