Li QL, Jiang B, Liu TY, Qin T. Endoscopic retrograde appendicitis therapy combined with electrohydraulic lithotripsy for stump appendicitis with abscess and fecalith: A case report. World J Gastrointest Surg 2026; 18(10): 123880 [DOI: 10.4240/wjgs.123880]
Corresponding Author of This Article
Ting Qin, MD, Department of Infectious Diseases, Suining Central Hospital, No. 27 Dongping North Road, Suining 629000, Sichuan Province, China. scsnqtwq@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
case-report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Li QL, Jiang B, Liu TY, Qin T. Endoscopic retrograde appendicitis therapy combined with electrohydraulic lithotripsy for stump appendicitis with abscess and fecalith: A case report. World J Gastrointest Surg 2026; 18(10): 123880 [DOI: 10.4240/wjgs.123880]
World J Gastrointest Surg. Oct 27, 2026; 18(10): 123880 Published online Oct 27, 2026. doi: 10.4240/wjgs.123880
Endoscopic retrograde appendicitis therapy combined with electrohydraulic lithotripsy for stump appendicitis with abscess and fecalith: A case report
Qian-Long Li, Biao Jiang, Tian-Yu Liu, Ting Qin
Qian-Long Li, Biao Jiang, Tian-Yu Liu, Department of Gastroenterology, Suining Central Hospital, Suining 629000, Sichuan Province, China
Ting Qin, Department of Infectious Diseases, Suining Central Hospital, Suining 629000, Sichuan Province, China
Author contributions: Li QL and Qin T contributed to manuscript writing and editing, and data collection; Jiang B and Liu TY contributed to data analysis; Qin T contributed to conceptualization and supervision. All authors have approved the final version of the manuscript.
AI contribution statement: The authors declare that no AI tools were utilized in this manuscript.
Supported by Guidance Project of Suining Municipal Health and Health Science and Technology Plan, No. 25CJDFB02.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Ting Qin, MD, Department of Infectious Diseases, Suining Central Hospital, No. 27 Dongping North Road, Suining 629000, Sichuan Province, China. scsnqtwq@163.com
Received: June 1, 2026 Revised: June 21, 2026 Accepted: July 1, 2026 Published online: October 27, 2026 Processing time: 132 Days and 1.3 Hours
Abstract
BACKGROUND
Stump appendicitis is a rare long-term complication after appendectomy. When complicated by intra-abdominal abscess and giant fecalith impaction, conventional treatment relies on secondary surgery, which is technically challenging and carries a high risk. Endoscopic retrograde appendicitis treatment (ERAT) and electrohydraulic lithotripsy (EHL) offer a novel minimally invasive option for such complex cases.
CASE SUMMARY
We report the case of a 42-year-old woman who presented with a 15-day history of right lower abdominal pain 8 years after appendectomy. Physical examination revealed right lower quadrant tenderness, and routine blood tests showed mild elevations in white blood cell count, neutrophil percentage, and procalcitonin levels. Abdominal computed tomography revealed stump appendicitis with intra-abdominal abscess and a giant impacted fecalith within the abscess cavity. Following the failure of anti-infective therapy, the patient underwent cholangioscope-assisted ERAT combined with EHL after providing informed consent. During the procedure, a large amount of purulent discharge was observed at the appendiceal orifice. The cholangioscopy was advanced into the residual appendiceal lumen and the adjacent abscess cavity, confirming giant fecalith impaction. Repeated attempts at basket extraction failed, and EHL was subsequently used to fragment the giant fecalith, followed by piecemeal basket retrieval. A plastic biliary stent was deployed for internal drainage. The patient experienced marked relief of abdominal pain. Two months later, the stent was removed, and the remaining fecalith fragments were completely retrieved. No recurrence has been observed to date.
CONCLUSION
For stump appendicitis complicated by intra-abdominal abscess and giant fecalith impaction, ERAT combined with EHL may be a safe, effective, and feasible minimally invasive treatment alternative.
Core Tip: This case reports the first use of endoscopic retrograde appendicitis treatment combined with electrohydraulic lithotripsy for stump appendicitis complicated by intra-abdominal abscess and giant fecalith impaction. Under cholangioscopic guidance, endoscopic retrograde appendicitis treatment combined with electrohydraulic lithotripsy enabled fecalith removal and internal stent drainage, avoiding high-risk secondary surgery. This innovative endoscopic strategy provides a novel, minimally invasive option, with the key benefit of avoiding highrisk reoperation.
