Mucus plug-induced obstruction in acute appendicitis

Mucus plug-induced obstruction in acute appendicitisA 53-year-old man was admitted for midupper abdominal pain and constipation for three days.The patient had a history of imperforate anus surgery.After admission, barium enema examination indicated localized stenosis of the anal canal and difficult defecation of contrast material.Colonoscopy showed the postoperative annus and appendiceal orifice edema with purulent secretion.With the possibility of appendicitis considered, endoscopic retrograde appendicitis therapy (ERAT) using an appendoscope (eyeMAX, 9-French; Micro-Tech (Nanjing) Co., Ltd., China) was prepared subsequently [1].During the operation, the appendoscope was inserted into the appendiceal lumen and a long strip of vitrina from the appendix opening to the terminus was detected ( Video 1, Fig. 1, Fig. 2).The vitrina was flushed out by the lavage of 0.5 % metronidazole.In addition to mucous hyperemia, no neoplasm was found in the following appendix exploration ( Fig. 3).The patient's abdominal pain was relieved immediately after the procedure.Finally, the vitrina was pathologically confirmed to be denatured necrosis ( Fig. 4).The patient was discharged three days later, and no recurrence or any other adverse event was noted during a two-month follow-up.To the best of our knowledge, this is the first reported en-doscopic diagnosis and treatment of mucus plug-induced obstruction in acute appendicitis. Endoscopy_UCTN_Code_TTT_1AQ_2AF Conflict of InterestThe authors declare that they have no conflict of interest.Video 1 Endoscopic diagnosis and treatment of mucus plug-induced obstruction in acute appendicitis. Fig. 1 Appendoscope passing through the appendiceal orifice and flushing out a long strip of vitrina. Fig. 2 Detecting a long strip of vitrina in the appendiceal lumen. Fig. 3 Exploring the appendix after removing the vitrina.