Removal of an Incidental Appendicolith Impacting the Appendiceal Orifice During Colonoscopy Screening

CASE REPORT A 65-year-old asymptomatic man underwent routine screening colonoscopy. Upon visualization of the cecum, a 1.5-cm appendicolith was discovered impacting the appendiceal orifice (Figure 1). This appendicolith was removed colonoscopically using Tripod graspers. The graspers were advanced into the appendiceal orifice and successfully grasped the appendicolith for complete extraction without fragmentation or injury to the mucosa (Figures 2–4). The appendicolith was then left within the colonic lumen and expected to pass spontaneously through the gastrointestinal tract, as it did not require any histopathological evaluation. Postprocedure, the patient remained asymptomatic and was discharged home without complications.Figure 1.: Appendicolith impacting appendiceal orifice visualized during colonoscopy.Figure 2.: Tripod forceps grasping appendicolith in appendiceal orifice.Figure 3.: Appendicolith removal from appendiceal orifice.Figure 4.: Postremoval view of appendiceal orifice.Appendicoliths are hard, calcified deposits within the appendix that commonly obstruct the appendiceal orifice, leading to an increased risk of acute appendicitis.1,2 They are most commonly identified on computed tomography rather than during colonoscopy.3 Visualization of appendicoliths in an asymptomatic patient during screening colonoscopy is very uncommon. This case demonstrates a minimally invasive strategy to prevent future risk of appendicitis and possible therapeutic role of colonoscopy when an appendicolith is visualized protruding from the appendiceal orifice and is accessible to be safely removed using standard retrieval forceps. DISCLOSURES Author contributions: S. Beeraka contributed to preparation of the case report, literature review, and manuscript drafting. D. Pannu contributed to case identification, procedural performance, and critical revision of the manuscript. Both authors approved the final version of the manuscript and agree to be accountable for all aspects of the work. D Pannu is the article guarantor and accepts full responsibility for the integrity of this work as a whole. Financial disclosure: None to report. Informed consent was obtained for this case report.