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 Table of Contents     
UNUSUAL CASE
Year : 2020  |  Volume : 16  |  Issue : 4  |  Page : 424-425
 

A large radiopaque appendicolith in an 8-year-old child


1 Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, Uttarakhand, India
2 Department of Radiology, Synergy Institute of Medical Sciences, Dehradun, Uttarakhand, India
3 Department of Anaesthesiology, Synergy Institute of Medical Sciences, Dehradun, Uttarakhand, India

Date of Submission16-Sep-2019
Date of Decision17-Sep-2019
Date of Acceptance23-Sep-2019
Date of Web Publication28-Jan-2020

Correspondence Address:
Dr. Rahul Gupta
Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun - 248 001, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmas.JMAS_229_19

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 ¤ Abstract 

Appendicoliths are one of the most common causes of acute appendicitis. However, giant radiopaque appendicoliths are rare, especially in paediatric age group. We report a case of acute appendicitis in an 8-year-old boy due to a large 2-cm radiopaque appendicolith treated successfully by laparoscopic appendectomy.


Keywords: Acute appendicitis, appendectomy, appendicolith, laparoscopy


How to cite this article:
Gupta R, Pokharia P, Varshney R. A large radiopaque appendicolith in an 8-year-old child. J Min Access Surg 2020;16:424-5

How to cite this URL:
Gupta R, Pokharia P, Varshney R. A large radiopaque appendicolith in an 8-year-old child. J Min Access Surg [serial online] 2020 [cited 2020 Oct 20];16:424-5. Available from: https://www.journalofmas.com/text.asp?2020/16/4/424/277079


An 8-year-old boy presented with complaints of pain in the right iliac fossa, vomiting and fever for 3 days. The patient had a history of robotic surgery being done for the left pelvicoureteric junction obstruction at the age of 3 years. On clinical examination, the patient was hemodynamically stable. The right iliac fossa tenderness was present. Routine blood investigations were within normal limits. Ultrasound of the abdomen revealed a long aperistaltic blind-ending tubular structure of 2 cm diameter with thickened wall suggestive of acute appendicitis. The abdominal radiograph showed 2 cm round radiopaque shadow in the right iliac fossa [Figure 1]. Contrast-enhanced computed tomography of the abdomen and pelvis revealed grossly dilated and thickened appendix with a 2-cm diameter appendicolith at its base suggestive of acute appendicitis [Figure 1]. On diagnostic laparoscopy, appendix was located in paracecal position and grossly distended, thickened, edematous with fecalith impacted at its base [Figure 2]. Cecum and terminal ileal loops were unremarkable. Laparoscopic appendectomy was done, and the patient had an uneventful recovery. Histopathology of the resected appendix confirmed the diagnosis of acute appendicitis.
Figure 1: Radiological findings: (a) Plain abdominal radiograph showing a round radiopaque lesion in the right iliac fossa. (b) Three-dimensional reconstruction computed tomography image of the abdomen showing the dilated and thickened appendix with a giant radiopaque appendicolith at its base

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Figure 2: Laparoscopic image demonstrating the dilated appendix containing the appendicolith (inset)

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Acute appendicitis is one of the most common abdominal emergencies. Appendicoliths are found in approximately 10% of patients with acute appendicitis.[1] They are mainly conglomerations of firm faeces with deposits of mineral such as calcium and struvite.[1] They are mostly <1 cm in size. Giant radiopaque appendicoliths (>2 cm), especially in paediatric population are extremely rare.[2] Most appendicoliths are asymptomatic. Acute appendicitis caused by appendicolith is more frequently associated with perforation and abscess formation.[1] However, the index case had uncomplicated appendicitis. Appendicolith can mimic a foreign body or urolithiasis in the absence of radiological evidence of acute appendicitis leading to diagnostic dilemma.[1],[2] Computed tomography is the best imaging modality for making the pre-operative diagnosis. In symptomatic cases with unclear pre-operative diagnosis, the diagnostic laparoscopy should be considered.

Asymptomatic cases with incidentally detected appendicoliths on radiological imaging do not require any treatment. However, considering the increased risk of complicated appendicitis, conservative management may not be suitable for symptomatic cases with appendectomy being the treatment of choice. Appendectomy can be done laparoscopically or by open technique depending on the available surgical expertise.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient's guardian has given their consent for the patient's images and other clinical information to be reported in the journal. The patient's guardian understands that the patient's name and initial will not be published, and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 ¤ References Top

1.
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.  Back to cited text no. 1
    
2.
Athawale HR, Vageriya N, Dhende NP, Patil S, Kotawala H. Giant appendicolith mimicking as foreign body: A case report. J Pediatr Surg Case Rep 2016;4:54-7.  Back to cited text no. 2
    


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