Retained Appendicolith in Children - a Case Report and Literature Review

Abstract

Objective − The aim of this report is to present the case of a child with a retained appendicolith. This occurs when an appendicolith is expelled from the appendix as a result of perforation and the failure to remove it during surgery. All previous cases with this complication were also searched through the PubMed search engine.

Case Report – We present the case of an eight-year-old boy who was referred to our clinic with an acute abdomen. An ultrasound indicated a perforated appendix. An open appendectomy was performed. The gangrenous perforated appendix was shown and removed. On the sixth postoperative day, an abdominal ultrasound was performed, showing several smaller purulent collections in the pelvis. Subhepatic to the right, a hyperechoic echo was verified, corresponding to a retained appendicolith. On the eleventh postoperative day, there was an increase in temperature with abdominal pain. Repeated ultrasound showed a denser subhepatic collection with previously verified appendicolith. A midline laparotomy was performed. Three abscess collections were found: pericecal, retrovesical, and subhepatic, in which drains were placed. The subhepatic appendicolith was found and was extirpated. A repeated ultrasound finding showed an orderly abdominal finding.

Conclusion – Our case, and the cases presented from the literature, clearly indicate that retained appendicolith, as a complication, will almost certainly form an abscess. In cases of perforated appendix, a retained appendicolith must always be considered in differential diagnosis as a possible cause of various symptomatologies. Upon confirmation by ultrasound or computed tomography, the surgeon must find a way to remove the appendicolith and resolve the abscess.