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

Abstract

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.

Zusammenfassung

Riesenappendikolithen (definiert als Appendikolithen mit einer Größe von mehr als 2 cm) werden mit weniger als 20 bisher dokumentierten Fällen als seltene Befunde angesehen. Im Allgemeinen werden Appendikolithen mit einem erhöhten Appendizitisrisiko und damit verbundenen Komplikationen, wie unter anderem Perforationen und Abszessen, in Verbindung gebracht. Über die klinischen Aspekte von Riesenappendikolithen ist dagegen nur wenig bekannt. Wir stellen einen Fall vor, bei dem ein Riesenappendikolith als Zufallsbefund während einer Vorsorgekoloskopie entdeckt wurde. Mit einem Durchmesser von mehr als 4 cm gehört dieser Appendikolith zu den bisher größten dokumentierten Steinen. Im Gegensatz zu bisherigen Publikationen von Riesenappendikolithen erwies sich unser Patient als vollkommen asymptomatisch. Wir geben darüber hinaus einen Überblick über die bisher publizierten Fälle von Riesenappendikolithen und diskutieren deren klinische Merkmale, das diagnostische Vorgehen und die Therapie.

Keywords

giant appendicolith - routine colonoscopy - ultrasound - minimal invasive surgery - cecal resection - appendectomy

Schlüsselwörter

Riesenappendikolith - Vorsorgekoloskopie - Ultraschall - minimalinvasive Chirurgie - Coecalpolresektion - Appendektomie

Publication History

Received: 13 May 2024

Article published online:
29 July 2024

• References

• 1 Weitzner ZN, Chung A, Naini BV. et al. Correlation of computed tomography, pathological findings, and clinical outcomes for appendicoliths in appendicitis. Ann Surg Open 2023; 4 (02) e280 DOI: 10.1097/AS9.0000000000000280. (PMID: 37601462)
• 2 Jones BA, Demetriades D, Segal I. et al. The prevalence of appendiceal fecaliths in patients with and without appendicitis. A comparative study from Canada and South Africa. Ann Surg 1985; 202 (01) 80-82 DOI: 10.1097/00000658-198507000-00013.
• 3 Haynes AL, Woodside JR. Periappendicitis presenting as left renal colic. Urology 1980; 16: 611-613 DOI: 10.1016/0090-4295(80)90572-5. (PMID: 7445312)
• 4 Cohen MS, Norris MA, Gruber MB. et al. Case profile: Appendictis and appendicolithiasis presenting as ureteral stone and colic. Urology 1981; 18: 623-624 DOI: 10.1016/0090-4295(81)90475-1.
• 5 Singh JP, Mariadason JG. Role of the faecolith in modern-day appendicitis. Ann R Coll Surg Engl 2013; 95 (01) 48-51 DOI: 10.1308/003588413X13511609954851. (PMID: 23317728)
• 6 Ranieri DM, Enzerra MD, Pickhardt PJ. Prevalence of appendicoliths detected at CT in adults with suspected appendicitis. AJR Am J Roentgenol 2021; 216 (03) 677-682 DOI: 10.2214/AJR.20.23149. (PMID: 33474985)
• 7 CODA Collaborative. A randomized trial comparing antibiotics with appendectomy for appendicitis. N Engl J Med 2020; 383 (20) 1907-1919 DOI: 10.1056/NEJMoa2014320. (PMID: 33017106)
• 8 Nitecki S, Karmeli R, Sarr MG. Appendiceal calculi and fecaliths as indications for appendectomy. Surg Gynecol Obstet 1990; 171 (03) 185-188 (PMID: 2385810)
• 9 Shindoh J, Niwa H, Kawai K. et al. Predictive factors for negative outcomes in initial non-operative management of suspected appendicitis. J Gastrointest Surg 2010; 14 (02) 309-314 DOI: 10.1007/s11605-009-1094-1. (PMID: 19936849)
• 10 Scroggie DL, Al-Whouhayb M. Asymptomatic giant appendicolith managed conservatively. J Surg Case Reports 2015; 2015 (11) 1-3 DOI: 10.1093/jscr/rjv149.
• 11 Ishiyama M, Yanase F, Taketa T. et al. Significance of size and location of appendicoliths as exacerbating factor of acute appendicitis. Emerg Radiol 2013; 20 (02) 125-130 DOI: 10.1007/s10140-012-1093-5. (PMID: 23179506)
• 12 Igwe PO, Okpani CP. Giant calculus of the appendix – report of three cases. Gaz Med 2016; 4 (01) 382-386
• 13 Van Zwalenburg C. The relation of mechanical distention to the etiology of appendicitis. Ann Surg 1904; 437-450
• 14 Wangensteen OH, Dennis C. Experimental proof of the obstructive origin of appendicits in man. Ann Surg 1939; 110: 629-647
• 15 Fitz RH. Perforating inflammation of the vermiform appendix. Tansactions of the Association of American Physicians. In: . 1886: 1-31
• 16 Bowers WF. A study of Appendiciits; with especial reference to its pathogenesis, bacteriology and healing. Ann Surg 1939; 39: 362-422 DOI: 10.1016/0002-9610(59)90345-9. (PMID: 13650081)
• 17 Rabinowitz CB, Egglin TK, Beland MD. et al. Outcomes in 74 patients with an appendicolith who did not undergo surgery: Is follow-up imaging necessary?. Emerg Radiol 2007; 14 (03) 161-165 DOI: 10.1007/s10140-007-0613-1.
• 18 Khan MS, Chaudhry MBH, Shahzad N. et al. Risk of appendicitis in patients with incidentally discovered appendicoliths. J Surg Res 2018; 221: 84-87 DOI: 10.1016/j.jss.2017.08.021.
• 19 Bhangu A, Søreide K, Saverio SD. et al. Acute appendicitis: modern understanding of pathogenesis, diagnosis and management. Lancet 2015; 386: 1278-1287 DOI: 10.1016/S0140-6736(15)00275-5. (PMID: 26460662)
• 20 Carr NJ. The pathology of acute appendicitis. Ann Diagn Pathol 2000; 4: 46-58 DOI: 10.1016/s1092-9134(00)90011-x. (PMID: 10684382)
• 21 Arnbjörnsson E, Bengmark S. Role of obstruction in the pathogenesis of acute appendicitis. Am J Surg 1984; 147: 390-392 DOI: 10.1016/0002-9610(84)90174-0. (PMID: 6322604)
• 22 Pahissa RA, Lin-Hurtubise KM. Giant appendicolith: A case report and review of the literature. Mil Med 2020; 185: e1851-e1853 DOI: 10.1093/milmed/usaa039. (PMID: 32196111)
• 23 Rampersad CA, Rampersad FS, Ramraj PR. et al. Case of a giant appendicolith. Cureus 2022; 14 (02) 1-6 DOI: 10.7759/cureus.22034. (PMID: 35340490)
• 24 Tepelidis C, Permekerlis A, Fotiadis P. et al. Appendicitis caused by a giant appendicolith. Cureus 2023; 15 (09) 1-6 DOI: 10.7759/cureus.45780. (PMID: 37872912)
• 25 Thapa N, Shrestha O, Basukala S. et al. Case of giant appendicolith: A common ailment with a rare finding. Clin Case Rep 2023; 11 (06) 1-4 DOI: 10.1002/ccr3.7372.
• 26 Chao HW. Colonoscopic removal of giant appendiceal fecalith without appendectomy for acute appendicitis – video vignette. Colorectal Dis 2018; 20 (11) 1056 DOI: 10.1111/codi.14413.
• 27 Keating JP, Sameer M. Giant appendicolith. Gastrointest Endosc 2005; 61: 292-3 DOI: 10.1016/s0016-5107(04)02547-7.
• 28 Teke Z, Kabay B, Erbiş H. et al. Appendicolithiasis causing diagnostic dilemma: A rare cause of acute appendicitis (report of a case). Ulus Travma Acil Cerrahi Derg 2008; 14 (04) 323-325 (PMID: 18988058)
• 29 Garg PK, Jain BK, Rathi V. et al. Giant appendicolith. Indian J Gastroenterol 2011; 30 (05) 243 DOI: 10.1007/s12664-011-0115-7. (PMID: 21922301)
• 30 Kaya B, Eris C. Different clinical presentation of appendicolithiasis. The report of three cases and review of the literature. Clin Med Insights Pathol 2011; 4: 1-4 DOI: 10.4137/CPath.S6757. (PMID: 21487530)
• 31 Kim DJ, Park SW, Choi SH. et al. A case of endoscopic removal of a giant appendicolith combined with stump appendicitis. Clin Endosc 2014; 47: 112-114 DOI: 10.5946/ce.2014.47.1.112.
• 32 Kumar K, Lewis D. Diagnostic confusion caused by a giant appendicolith: A case report. J Med Cases 2015; 6 (02) 71-3 DOI: 10.14740/jmc2032w.
• 33 Singhal S, Singhal A, Mahajan H. et al. Giant appendicolith: Rare finding in a common ailment. J Minim Access Surg 2016;2015– 2017; DOI: 10.4103/0972-9941.178514. (PMID: 27073312)
• 34 Abebe E, Abebe K. Giant appendicolithiasis presenting with chronic abdominal pain and mass: A case report. Ethiop J Health Sci 2019; 29 (03) 417-419 DOI: 10.4314/ejhs.v29i3.16.
• 35 Salemis N. Giant appendicolith, a rare cause of chronic right iliac fossa pain. Am Surg 2012; 78 (11) E493-494 (PMID: 23089431)
• 36 Song M, Liu Z, Zhao LX. et al. Endoscopic retrograde appendicitis therapy for treating a giant hard appendicolith embedded in the appendiceal orifice: A case report. Asian J Surg 2021; 44 (02) 488-489 DOI: 10.1016/j.asjsur.2020.11.007. (PMID: 33191073)
• 37 Khan MS, Chaudhry MBH, Shahzad N. et al. The characteristics of appendicoliths associated with acute appendicitis. Cureus 2019; 11 (08) 1-7 DOI: 10.7759/cureus.5322.
• 38 Lowe LH, Penney MW, Scheker LE. et al. Appendicolith revealed on CT in children with suspected appendicitis: How specific is it in the diagnosis of appendicitis?. AJR Am J Roentgenol 2000; 175: 981-984 DOI: 10.2214/ajr.175.4.1750981.
• 39 Kubota A, Yokoyama N, Sato D. et al. Treatment for appendicitis with appendicolith by the stone size and serum c-reactive protein level. J Surg Res 2022; 280: 179-185 DOI: 10.1016/j.jss.2022.06.009.