A 67-year-old man presented with pain and tenderness in the right lower quadrant.
Abdominal computed tomography (CT) scan was performed, which revealed appendicitis
and appendiceal fecaliths ([Fig. 1]). The patient was admitted to our hospital for endoscopic retrograde appendicitis
therapy (ERAT). The procedure was performed using a 3.2-mm biopsy channel colonoscope
(CF-H290I; Olympus) with successful intubation of a single-use subscope (9-Fr eyeMax;
Micro-Tech) into the appendiceal cavity. The subscope demonstrated that the cavity
wall of the appendix lumen was slightly hyperemia and edema, and appendiceal fecaliths
were found within the appendiceal lumen ([Fig. 2]
a). Plenty of normal salines was used to rinse out the fecaliths ([Fig. 2]
b). Subsequently, a 1.2-cm laterally spreading tumor was identified within the appendiceal
lumen, characterized by a rough, granular mucosal surface covered by a mucous cap
([Fig. 3]
a, [Video 1]). Methylene blue staining revealed a clear boundary ([Fig. 3]
b). A biopsy was performed. The pathological findings of the biopsy were sessile serrated
lesions (SSLs) ([Fig. 4]).
Fig. 1 The abdominal CT revealed appendicitis and appendiceal fecalith (the red arrow).
Fig. 2
a The appendiceal fecaliths in the appendix lumen. b The appendiceal fecaliths were rinsed out.
Fig. 3
a The lesion was an area of rough, granular mucosa (the white arrow) in the appendix
lumen. b Methylene blue staining showed a clear boundary.
The detection and biopsy of the lesion confined to the lumen of the appendix by the
single-use subscope imaging system during endoscopic retrograde appendicitis therapy.Video
1
Fig. 4 Biopsy pathology of the lesion.
After obtaining informed consent, a laparoscopic appendectomy was performed. During
the procedure, it was observed that the appendix was elongated and exhibited mild
adhesions to the surrounding tissues. The rough area in the appendiceal lumen was
obvious at postoperative specimen ([Fig. 5]
a. The presence of SSL with low-grade dysplasia was confirmed by the postoperative
histopathological analysis ([Fig. 5]
b).
Fig. 5
a The rough area (the vascular clamp pointed) in the appendix lumen at the removed
appendix. b Pathology of the lesion in the appendix lumen.
Postoperatively, the patient was given antibiotics therapy and fasted for 3 days.
He recovered quickly from mild abdominal pain and was discharged 4 days later. The
symptoms of right lower quadrant pain and tenderness were significantly relieved.
Appendiceal SSLs are lesions with malignant potential, they are rarely reported and
mainly incidental findings in appendectomy specimens [1]
[2]. This case demonstrates the utility of the single-use subscope imaging systems in
managing appendicitis and detecting appendiceal lesions, providing clear visualization
and enabling precise diagnosis and treatment. It provides a possible technique for
the early detection and pathological diagnosis of lesions confined within the lumen
of the appendix.
Endoscopy_UCTN_Code_CCL_1AD_2AB
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