Percutaneous removal of a retained appendicolith causing recurrent perihepatic abscesses between the liver and diaphragm

Abstract

Many cases of appendicitis can be associated with appendicoliths. These may sometimes be lost during appendectomies and may be lodged in the body. Most of these cases lead to recurrent abscess formation, and these appendicoliths invariably need removal. Typically, this used to be done as an open surgery or laparoscopically. Here we describe the case of a transcutaneous removal of an appendicolith that was lodged between the liver and diaphragm that led to recurrent perihepatic abscess formation in a 24-year-old otherwise healthy man. The patient made a successful recovery without any recurrence. A transcutaneous approach to remove a retained appendicolith may be a feasible, a safe and an easy method to extract appendicoliths that are accessible for transcutaneous removal.

A recurrent retrohepatic abscess secondary to a dropped appendicolith

“…Perihepatic abscesses resulting from dropped appendicoliths are uncommon and a review of the literature has revealed 11 cases in 10 reports, including the present one ( Table 1 ) [ [6] , [7] , [8] , [9] , 11 , [15] , [16] , [17] , [18] ]. All 11 patients had appendicectomy for perforated appendicitis and presumably, the dropped appendicoliths were secondary to the perforation.…”

“…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] .…”

“…One patient was successfully managed with antibiotics without drainage of the abscess [17] , but this is the exception rather than the rule. Two patients had successful percutaneous drainage of the abscess with subsequent (up to several weeks later) percutaneous extraction of the appendicolith [7 , 18] . One patient had successful percutaneous drainage of the abscess without retrieval of the appendicolith [11] and two had percutaneous drainage of the abscess with subsequent surgical retrieval of the appendicolith [11 , 15] .…”

“…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] .…”

Benefits of conservative management of a retained appendicolith after laparoscopic appendectomy: A case series

“…They are often localized in the pelvis, including the para-cecal region and Morison's pouch [ 5 ]. However, Abdullah and Singh reported an appendicolith located around the liver, causing perihepatic abscesses [ 6 , 7 ].…”