Appendiceal orifice: more than it meets the eye

A healthy and asymptomatic 38-year-old man presented with accidental foreign body ingestion. The abdominal X-ray showed a radiopaque image in the right inferior quadrant ([Fig. 1]). An abdominopelvic computed tomography (CT) scan was performed and showed a metallic-density image apparently within the cecal appendix without evidence of an inflammatory process ([Fig. 2]).

Fig. 1 Abdominal X-ray showing a radiopaque image in the right inferior quadrant.

Fig. 2 Abdominopelvic computed tomography scan showing a metallic-density image apparently within the cecal appendix without evidence of an inflammatory process.

In this context, the patient was submitted to a colonoscopy and there was no evidence of a foreign body after intubation of the cecum and observation of the appendiceal orifice. After several attempts to access the appendiceal orifice using a grasping forceps, an object was identified as a dental implant ([Video 1]). It was removed and then retrieved using a snare ([Fig. 3]). The patient remained well and asymptomatic after the procedure.

Video 1 Retrieval of a foreign body from the inside of the appendix.

Fig. 3 Dental implant retrieved from the appendix.

Foreign bodies in the appendix have been described and complications such as acute appendicitis and appendiceal abscess can occur, especially with sharp, stiff, and metallic objects [1]. Endoscopic removal of the object has been suggested when an object is identified in the appendiceal orifice and there is no evidence of inflammation or other complication [2]. Clinical and imagiological follow-up is also an option, and some patients will have spontaneous expulsion of the object [3]. Nonetheless, surgery is indicated when endoscopic or spontaneous removal is not possible or when there are signs of peritoneal inflammation [1] [4] [5].

To the best of our knowledge, this is the first reported case of endoscopic removal of a foreign body inside of the appendix.

In conclusion, patients presenting with foreign body ingestion and radiological image in the right lower abdominal quadrant may present with a broad spectrum of severity. The endoscopist must keep in mind the possibility of a foreign body lodged in the appendix and the possibility of its endoscopic removal. However, it is mandatory to exclude the presence of an inflammatory process, which may warrant emergency surgery.

Endoscopy_UCTN_Code_CCL_1AD_2AH

Publication History

Article published online:
19 July 2021

• References

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