Acute Appendicitis With Periappendiceal Abscess Caused by Migration of an Endoscopic Clip Into the Appendix: A Case Report

Acute appendicitis is a common surgical emergency, most often caused by luminal obstruction. However, appendicitis resulting from the migration of an endoscopic clip is extremely rare. Because non-absorbable foreign bodies are unlikely to be expelled spontaneously from the appendix, their presence has important implications for management. An 82-year-old woman presented with right lower abdominal pain. Four years earlier, she had undergone colonoscopic polypectomy with endoscopic clipping for hemostasis. Contrast-enhanced computed tomography revealed a periappendiceal abscess and a high-density foreign body near the appendiceal base, suggestive of a migrated endoscopic clip. Initial management with percutaneous abscess drainage and intravenous antibiotics was performed according to institutional protocol; however, the patient’s condition deteriorated, with worsening inflammatory markers and signs of peritonitis. Emergency surgery was therefore undertaken on hospital day 2. Open appendectomy with partial cecectomy and intraperitoneal drainage was performed. Examination of the resected specimen revealed an endoscopic clip within the appendiceal lumen. Histopathological analysis confirmed phlegmonous acute appendicitis. Appendicitis caused by non-absorbable foreign bodies, such as endoscopic clips, is unlikely to resolve with conservative management. Based on this case and a review of the literature, early surgical intervention may be considered, even in the presence of an abscess. Recognition of this condition is essential to avoid delays in definitive treatment.