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Dropped Appendicolith: CT Findings and Implications for Management

Ajay K. Singh1,2, Peter F. Hahn2, Debra Gervais2, Gopal Vijayraghavan1 and Peter R. Mueller2

1 Department of Radiology, University of Massachusetts Memorial Medical Center, Worcester, MA.
2 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114.


Figure 1
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  		Fig. 1 —9-year-old girl with dropped appendicolith after open appendectomy for suppurative appendicitis. Contrast-enhanced CT scan obtained 10 days after appendectomy shows abscess (arrowhead) containing appendicolith (arrow). Abscess was drained under sonographic guidance, but attempts at retrieval of appendicolith with snare failed.

 

Figure 2
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  		Fig. 2 —42-year-old man with dropped appendicolith after open appendectomy. Contrast-enhanced CT scan obtained 14 days after surgery because of increasing right lower quadrant pain and elevated WBC count shows right lower quadrant abscess (arrow) with calcified appendicolith (arrowhead). Surgical drainage was performed, and patient made full recovery.

 

Figure 3
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  		Fig. 3A —34-year-old woman with dropped appendicolith in Morison's pouch. Contrast-enhanced CT scan obtained 7 days after appendectomy shows Morison's pouch abscess containing appendicolith (arrowhead).

 

Figure 4
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  		Fig. 3B —34-year-old woman with dropped appendicolith in Morison's pouch. Unenhanced CT scan shows pigtail drainage catheter (arrow) in Morison's pouch abscess.

 

Figure 5
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  		Fig. 3C —34-year-old woman with dropped appendicolith in Morison's pouch. Follow-up CT scan after successful drainage of abscess shows faintly visible persistent appendicolith (arrowhead) in Morison's pouch.

 

Figure 6
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  		Fig. 4A —24-year-old man with retained appendicolith managed with percutaneous retrieval. Axial contrast-enhanced CT scan after appendectomy shows abscess containing appendicolith (arrow) in right lower quadrant.

 

Figure 7
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  		Fig. 4B —24-year-old man with retained appendicolith managed with percutaneous retrieval. Axial CT scan shows 22-mm-diameter Wittich nitinol stone basket (arrow) passed through 12-French sheath to retrieve appendicolith.

 

Figure 8
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  		Fig. 4C —24-year-old man with retained appendicolith managed with percutaneous retrieval. Photograph shows Wittich nitinol stone basket (curved arrow) and retrieved appendicolith (straight arrow).

 

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