Endoscopic appendiceal orifice myotomy to remove an impacted appendiceal fecalith.

A 74-year-old woman with hypertension and diabetes mellitus underwent colonoscopy for intermittent lower abdominal pain for about 3 months. A protruding appendix was noted (Figure A). Computed tomography images demonstrated an oval calcific fecalith located at the appendix (Figure B, red arrow). The patient refused surgery and chose endoscopic therapy. We planned to perform endoscopic appendiceal orifice myotomy (EAOM), similar to endoscopic sphincter myotomy to remove impacted duodenal papillary stones. EAOM was performed with an incision from the top of the appendiceal protruding part to the opening using the Goldknife (Micro-tech, Nanjing, China) with an endoscopic ST hood cap (Figure C). A solution of saline with a small amount of indigo carmine was injected, and the Goldknife was used to deliver water from the tip of the knife and reduce the number of device changes. The fecalith was removed successfully after EAOM (Figure D), with the help of a transparent cap. The incision was closed with 2 hemostatic clips. There were no immediate complications, and the total procedure time was 8 minutes. The patient's abdominal symptoms resolved on the second day after EAOM. The patient was observed in the hospital for a few days, and was discharged uneventfully. No recurrence or any other adverse event was noted during a 2-month follow-up. To our knowledge, this is the first reported use of EAOM for an impacted appendiceal fecalith. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI5N2E1MmQxMTgzYjI5YjgzMTIzMmRlNTgyMmZkMmIzOCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNzAyMTU1MDA2fQ.ozgmcHPxQtsg9x2sNv_eEqoyQuYwfgp2L9Dg64vFWuIEG1j2kM3wdoUiAur8hPM_xgcvGYpHpVpf7IuMDDoElY927t5ck_DsBomhdfjQqDxyy0bITXDq5ev-q2l8_mWhTlIM8-ynpzsKS1KLPHVcjFQ6xjS94o7Wt7TNk4kvYNePSBIfkZar5SHMZ9xzMyw1FDSzRcNHesX4MmLZ0NyCiJ95MiokmjVZXJj1vVtWaoqfO-GMyo-59S-8x01qV1OkOqn67C_IPhIY3clhP-TxG9V4blxFJ9u5CL-dzHnm_dzWNUSinJHU6syXSe2saq6BAZM14n7yo1q7mVX68Dt4KQ Download .mp4 (33.77 MB) Help with .mp4 files Video