Retained appendicolith: Some things work themselves out

Abstract

Management of perforated appendicitis has been debated for decades, remaining controversial today. Data is scarce regarding the approach to retained appendicolith after appendectomy. A 14-year-old girl presented with perforated appendicitis and an extraluminal appendicolith. IV antibiotics were initiated and drain placed until resolution of intraabdominal abscess. The drain was removed, and she was discharged on oral antibiotics. Ten days later she developed pain and purulent drainage from the drain site and was found to have a reaccumulated collection, so antibiotics were restarted, and she improved. Weeks later interval laparoscopic appendectomy ensued; the appendix was inflamed, and purulent fluid was noted in the pelvis. She initially recovered until multiple abscess recurrences, first temporized by percutaneous drainage, and subsequently by 6 weeks of antibiotics. Finally, workup of progressive right hip pain and swelling revealed a subcutaneous collection containing a shadowing echogenic lesion, consistent with the appendicolith from initial CT. Incision and drainage yielded pus and a 12 mm brown calcified mass; packing was placed. She was discharged on amoxicillin and continued wound care. Pathologic evaluation described a mass of calcified degenerated vegetable matter and food particles consistent with an appendicolith. Two years later she is without recurrent symptoms.