Abstract
Acute appendicitis is a disease with multifactorial etiology and frequently includes lumen obstruction. Appendicoliths can pose a challenge during the appendectomy procedure if not identified.
This is a prospective case series at our academic institution involving two medically free patients with intra-abdominal abscess formation secondary to an overlooked appendicolith who were treated conservatively with a follow up period of one year for each patient.
Complications of a retained appendicolith are serious and include intra-abdominal abscess, perihepatic abscess, and delayed wound healing through fistula formation, most surgeons would undergo surgical removal with preoperative localization of the appendicolith using different modalities. In contrast, conservative management is an emerging approach to managing such conditions. The conservative approach involves percutaneous retrieval and the IR-guided draining of an intra-abdominal collection. In our cases, percutaneous drainage and intravenous antibiotics were a successful treatment, with no abscess recurrence in over a year.
We suggest that patients with appendicoliths presenting with appendicitis should undergo appendicolith removal to prevent the risk of recurrent abscess formation. We also consider that the conservative management of patients with appendicoliths presenting with recurrent abdominal pain and abscesses after appendectomy is a better and safer approach than the surgical removal of a dropped appendicolith, as the risks of the surgical procedure complications can be avoided.
•Considering retained appendicolith as a differential diagnosis after appendectomy in patients with postoperative intra-abdominal collections.•Understanding the role of IR drainage in managing patients with a retained appendicolith.•Emphasizing the Role of conservative management over Surgical intervention in patients diagnosed with retained appendicolith