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SpyGlass-Guided Laser Lithotripsy for the Treatment of Giant Appendiceal Fecalith: First Human Case Report

Kong, Ling-Jian PhD1; Zhang, Ji-Yu MD1; Ullah, Saif MD1; Liu, Bing-Rong MD, PhD1

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The American Journal of Gastroenterology: October 2021 - Volume 116 - Issue 10 - p 1981-1982
doi: 10.14309/ajg.0000000000001409

Appendectomy remains the first selectivity for adult appendicitis with appendiceal fecalith. However, the risk of appendiceal fecaliths falling into the peritoneal cavity resulting in serious postoperative complications remains high. In addition, the appendix, which believed to have significant immune functions, is also removed. Here, we report our experience of the SpyGlass-guided laser lithotripsy for the treatment of a giant appendiceal fecalith.

A 40-year-old man was admitted to our hospital with intermittent right lower abdominal pain without fever for 15 days. The computed tomography scan showed thickened wall of the appendix and a nondense fecal stone shadow in the appendiceal cavity (a). An endoscope with a transparent cap attached on the tip was advanced into the cecum where edema of the opening of appendix was clearly seen. A guide wire was inserted into the appendix under fluoroscopic guidance showing a huge oval 1.5 * 1.2-cm filling defect (b). A balloon dilation catheter with a diameter of 10 mm was used to expand the appendiceal cavity, and Spyglass laser lithotripsy using U100 excitation was performed (c, d, e). A large amount of yellow and white hard fecal stones were removed with a stone basket extractor and foreign body forceps (f). The appendix cavity was repeatedly washed with normal saline. A plastic stent (8.5 Fr, 6-cm length, COOK) was then placed along the guide wire. The total procedure time was 53 min. Abdominal pain was relieved immediately after the procedure. The stent was removed 1 month after the procedure. No recurrence or any other adverse event had been noted during the 3-month follow-up.

Spyglass-guided laser lithotripsy using endoscopic retrograde appendicitis therapy has the ability to solve the problem of huge hard stones within the appendix. This technique provides a feasible new alternative treatment for patients who are unwilling or unable to undergo appendectomy. This minimally invasive organ-sparing procedure both relieved the obstruction and preserved the physiological function of the appendix. (Watch the Video, Supplementary Digital Content 1, (Informed consent was obtained from the patient to publish these images.)

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© 2021 by The American College of Gastroenterology