Conservative Management of a Retained Appendicolith via Percutaneous Drainage Following Laparoscopic Appendectomy: A Case Report

Retained appendicolith is an uncommon but recognized complication following laparoscopic appendectomy that can result in the formation of an intra-abdominal abscess. Although surgical retrieval of the stone is generally recommended to prevent recurrence, the optimal management strategy remains controversial. We report a case of a 16-year-old male patient who underwent an urgent laparoscopic appendectomy for acute complicated appendicitis. Intraoperative injury to the appendix resulted in the spillage of the appendicoliths into the peritoneal cavity. The postoperative course was initially uneventful. On postoperative day 3, the patient was asymptomatic with a normalized white blood cell count; consequently, antibiotics were discontinued, and the intra-abdominal drain was removed following confirmed normal output. The patient was discharged on postoperative day 6. Two days after discharge, the patient presented to the outpatient clinic with abdominal pain and purulent discharge from the drain site, leading to readmission. A CT scan revealed an intra-abdominal abscess caused by a retained appendicolith. CT-guided percutaneous drainage was performed, which led to the immediate resolution of abdominal pain within 24 hours. The abscess cavity was irrigated daily with normal saline, and the drainage fluid remained mostly clear from the first morning after insertion. Four days after the drainage tube placement, retrieval of the retained appendicolith was attempted using an 11-Fr angiographic sheath inserted through the existing drainage tract under fluoroscopic guidance. The stone (approximately 3 mm in diameter) could not be removed despite repeated irrigation. Given the small size of the appendicolith and adequate infection control achieved with drainage and irrigation, conservative management was chosen. The potential risks were thoroughly explained to the patient and his caregivers, who confirmed their understanding. A follow-up CT scan at six months after surgery revealed no intra-abdominal abscess, and the appendicolith had disappeared. Although the removal of retained appendicoliths is generally advocated, careful observation after sufficient drainage may be a reasonable and safe option for certain patients.