Avoiding appendectomy with an ultrasound probe

• Published in: Annals of the Royal College of Surgeons of England Vol. 104; no. 3; pp. e81 - e83
• Main Authors: Oikonomou, P, Nikolaou, C, Chrisafis, I, Romanidis, K, Tsalikidis, C, Pitiakoudis, M
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-03-2022; Royal College of Surgeons
• Subjects: Abdomen; Adult; Appendectomy; Appendicitis; Appendicitis - diagnostic imaging; Appendicitis - etiology; Appendicitis - therapy; Appendix - diagnostic imaging; Asymptomatic; Democritus (460?-370?); Emergency medical care; Fecal Impaction - complications; Fecal Impaction - diagnostic imaging; Female; Hospitals; Humans; Inflammation; Magnetic resonance imaging; Online Case Report; Pain; Patients; Ultrasonic imaging; Ultrasonography; Greece; Thrace; Appendicolith; Appendicitis; Appendiceal colic; Ultrasound; Appendiceal faecolith
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/rcsann.2021.0122

Acute appendicitis is common in patients with right lower quadrant pain and affects all gender and age groups. Because clinical diagnosis of patients with right lower quadrant pain remains a challenge to emergency physicians and surgeons, imaging is of major importance. Ultrasound has well-established direct and indirect signs for diagnosing acute appendicitis and revealing the presence of an appendicolith. Appendectomy, which can be either open or laparoscopic, constitutes the basic treatment. However, the need for an appendectomy is debatable, particularly in high-risk patients. We report the case of a 42-year-old woman with no relevant medical history who was sent to the emergency department by her family physician with right lower quadrant pain of 18 hours' duration. Using ultrasound, the emergency physicians identified, inside the appendix, a 0.6cm appendiceal faecolith, migration of which was eventuated by manipulation of the ultrasound probe. The patient was then successfully treated non-operatively without any antibiotic prescription. Despite its rarity, migration of an appendiceal faecolith is possible. When migration of an appendicolith is perhaps actualised spontaneously or by ultrasound probe manipulation, the likelihood of an appendectomy decreases dramatically. This hypothesis provides patients who present an appendiceal faecolith with an alternative treatment approach that will lead to the avoidance of surgery, minimise morbidity and reduce hospitalisation costs.