Appendicoliths, the little giants: A narrative review

Babington, Emmanuel A.

doi:10.1016/j.radi.2022.09.006

Cited by 6 publications

(8 citation statements)

References 26 publications

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“…Like spilled gallstones [10] , dropped appendicoliths can cause a plethora of intra- and extra-abdominal complications. Spillage of the appendicolith usually occurs in the pelvis, paracaecal region, Morison's pouch (posterior subhepatic space), or between loops of the small bowel [1 , 2 , 11] . However, the appendicolith can migrate to any part of the peritoneal cavity, the muscles of the abdominal wall, and even transdiaphragmatically [1 , 2 , 12] .…”

Section: Discussionmentioning

confidence: 99%

“…Spillage of the appendicolith usually occurs in the pelvis, paracaecal region, Morison's pouch (posterior subhepatic space), or between loops of the small bowel [1 , 2 , 11] . However, the appendicolith can migrate to any part of the peritoneal cavity, the muscles of the abdominal wall, and even transdiaphragmatically [1 , 2 , 12] . This migration can result in complications such as intra-abdominal abscesses [7] , hepatic abscesses [13] , intramuscular abscesses [5] , fistulae [1] , pneumonia with empyema [12] , migration to the subcutaneous tissues and delayed wound healing [1 , 14] .…”

Section: Discussionmentioning

confidence: 99%

“…Appendicoliths are formed within the lumen of the vermiform appendix due to aggregation of faecal matter and inorganic salts, and usually present as calcific masses within the appendicular lumen [1 , 2] . Appendicoliths may be identified on computed tomography (CT) scanning in up to 30% of individuals [3] and although they do not predispose to appendicitis per se , their presence is a risk factor for failure of nonoperative treatment of acute appendicitis [4] .…”

Section: Introductionmentioning

confidence: 99%

“…Appendicoliths can drop into the peritoneal cavity during the course of an appendicectomy, or more commonly as a result of perforated appendicitis. Retained or dropped appendicoliths can migrate to various parts of the peritoneal cavity, retroperitoneum, or even the chest, and result in abscess formation [1 , 2 , [5] , [6] , [7] , [8] , [9] .…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A recurrent retrohepatic abscess secondary to a dropped appendicolith

Sheikh,

Kaur,

Zaitoun

et al. 2024

Radiology Case Reports

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A recurrent retrohepatic abscess secondary to a dropped appendicolith

Sheikh,

Kaur,

Zaitoun

et al. 2024

Radiology Case Reports

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“…Giant appendicoliths (>2 cm) are rare and often surgically removed due to the increased risk of complications such as perforation or abscess [ 1 , 2 ]. They are more prevalent in children and young adults, particularly in males, and with the presence of a retrocecal appendix [ 3 - 5 ]. The occurrence of appendicoliths in cases of appendicitis varies, ranging from 10% to 55% [ 4 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of the Largest Documented Appendicolith in Literature: A Case Report

Hennenberg,

Zott,

Berger-Kulemann

et al. 2024

Cureus

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This case report depicts the diagnosis and management of the largest documented appendicolith found in the medical literature so far, measuring 4.5 cm. A 44-year-old male patient presented with a distended abdomen, right lower quadrant (RLQ) pain, constipation, and the inability to consume solid food. Laboratory tests revealed leukocytosis and elevated C-reactive protein (CRP) levels. Abdominal X-rays showed a densely calcified structure in the right lower quadrant, and further imaging confirmed the diagnosis of appendicolithiasis. The surgical indication for appendectomy was determined, and an open surgical procedure was performed due to the severity of inflammation, minimal perforation, and extensive adhesions. The surgically removed appendix with the appendicolith was analyzed histologically, confirming appendicolithiasis, periappendicitis, perforation, and serositis. The patient was discharged in stable condition after postoperative management. Giant appendicoliths are rare and associated with an increased risk of complications. Diagnosis is typically clinical but can be enhanced by imaging modalities.

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CT of appendicoliths in adult appendicitis: clinical significance and characteristics of overlooked cases

Kaewlai,

Wongveerasin,

Lekanamongkol

et al. 2023

Eur Radiol

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Objectives Accurate computed tomography (CT) identification of appendicoliths in adults with acute appendicitis is crucial as it may preclude nonoperative management due to high risk of failure and complications. This investigation aimed to identify the significance of appendicoliths in acute appendicitis and to evaluate the performance of portovenous-phase (PVP) CT and the consequences of overlooked appendicoliths. Methods CT examinations of 324 consecutive patients (mean age 51.9 years, 112 men) with pathologically confirmed acute appendicitis were retrospectively included. Two radiologists independently reviewed the images, and disagreement was resolved by a consensus. Results Appendicoliths were identified in 134/324 patients, of which 75 had complicated appendicitis. Among 190 patients without appendicoliths, 52 had complicated appendicitis. An appendicolith was independently associated with complicated appendicitis (adjusted odds ratio 2.289; 95% CI: 1.343–3.902; p = 0.002). The larger minimum diameter was significantly associated with complication. The 4.5-/6.0-mm cutoffs for minimum and maximum diameters of appendicoliths demonstrated 82.7%/85.3% sensitivity and 35.6%/33.9% specificity in predicting complications. The PVP alone had 82.1–88.1% sensitivity, respectively per patient and per appendicolith, and a 100% specificity in the detection of appendicoliths, as compared with combined noncontrast and PVP. PVP overlooked 28/237 appendicoliths (11.8%) corresponding to 24/134 patients (17.9%). Of the 24 patients with overlooked appendicoliths, 16 had complicated appendicitis but 14 were correctly categorized by findings other than appendicoliths. In total, 2/127 patients (1.6%) with complicated appendicitis were misdiagnosed as having uncomplicated appendicitis. Conclusions Appendicoliths in acute appendicitis were strongly associated with complications. While PVP overlooked some appendicoliths, only 1.6% of complicated appendicitis were misclassified when considering other CT findings. Clinical relevance statement This study found a strong association between appendicoliths and complications. Its presence may preclude conservative management. Although portovenous-phase CT overlooked some appendicoliths, the combination with other CT findings allowed correct classification in a vast majority of cases. Key Points • Accurate identification of appendicoliths is crucial for nonoperative management decisions in adult acute appendicitis. • Appendicoliths are strongly associated with complications in adult acute appendicitis. • Portovenous-phase CT overlooked some appendicoliths, but only a small percentage of patients with complicated appendicitis were misclassified when considering other CT findings.

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Appendicoliths, the little giants: A narrative review

Cited by 6 publications

References 26 publications

A recurrent retrohepatic abscess secondary to a dropped appendicolith

A recurrent retrohepatic abscess secondary to a dropped appendicolith

Diagnosis and Management of the Largest Documented Appendicolith in Literature: A Case Report

CT of appendicoliths in adult appendicitis: clinical significance and characteristics of overlooked cases

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