Asymptomatic giant appendicolith managed conservatively

Abstract

A 67-year-old lady was found to have a giant appendicolith during a colorectal cancer screening colonoscopy, following a positive faecal occult blood test. Computed tomography confirmed the presence of a calcified giant appendicolith within the base of the appendix, which otherwise appeared normal. Appendicoliths are widely believed to be a major cause of acute appendicitis via obstruction of the appendix lumen, although this is disputed due to a lack of strong evidence. They may also cause chronic abdominal pain. All of the few cases of giant appendicoliths reported so far have been managed by extracting the lesions. Our patient was asymptomatic and had bilateral lung transplants, so a conservative watchful waiting approach was adopted. The authors propose expectant management of giant appendicoliths as a reasonable option in patients with significant operative risks.

Figure 1:

Anterior–posterior radiograph of the pelvis demonstrating a calcified ovoid lesion projected over the right sacral ala.

Figure 2:

Axial, coronal and sagittal CT views showing a giant appendicolith within the base of the appendix. Calcification and the laminar structure are well demonstrated on CT.