Giant appendicolith

Routine colonoscopy with a surprise in the cecum: It's a giant appendicolith! A Case report and review of the literature

Giant appendicoliths (defined as appendiceal stones larger than 2 cm in size) are rare findings, with less than 20 well-documented reported cases. Appendicoliths, in general, are linked to an increased risk of appendicitis and associated complications. However, little information is available on the clinical impact of giant appendicoliths. We present a case of a giant appendicolith accidentally discovered during screening colonoscopy. With more than 4 cm, this appendicolith is one of the largest of the few reported so far. In contrast to all other cases of giant appendicoliths, the patient did not exhibit any symptoms. Additionally, we provide an overview of giant appendicolith cases, discussing their clinical features, diagnosis, and treatment.

Asymptomatic giant appendicolith managed conservatively

A 67-year-old lady was found to have a giant appendicolith during a colorectal cancer screening colonoscopy, following a positive faecal occult blood test. Computed tomography confirmed the presence of a calcified giant appendicolith within the base of the appendix, which otherwise appeared normal. Appendicoliths are widely believed to be a major cause of acute appendicitis via obstruction of the appendix lumen, although this is disputed due to a lack of strong evidence. They may also cause chronic abdominal pain. All of the few cases of giant appendicoliths reported so far have been managed by extracting the lesions. Our patient was asymptomatic and had bilateral lung transplants, so a conservative watchful waiting approach was adopted. The authors propose expectant management of giant appendicoliths as a reasonable option in patients with significant operative risks.

A case of endoscopic removal of a giant appendicolith combined with stump appendicitis

Stump appendicitis is an acute inflammation of the residual appendix and is a rare complication after appendectomy. The physician should be aware of the possibility of stump appendicitis in patients with right lower abdominal pain after appendectomy so that delayed diagnosis and treatment can be prevented. Stump appendicitis is usually treated by surgical resection, and endoscopic treatment has not been reported previously. A 48-year-old man who had undergone appendectomy 35 years earlier presented to the hospital because of right lower quadrant discomfort. A computed tomography scan showed a large stone in the residual appendix. Colonoscopic findings revealed a large, smooth, protruding lesion at the cecum with a stone inside the appendiceal orifice. Endoscopic removal after incision of the appendiceal orifice was performed successfully.