ERAT combined with electrohydraulic lithotripsy for the treatment of chronic appendicitis with giant fecal stones in the appendix: A case report

RATIONALE: Endoscopic retrograde appendicitis therapy (ERAT) has emerged as a minimally invasive treatment option for acute uncomplicated appendicitis. However, its application in chronic appendicitis with giant appendicoliths is rarely reported. Such cases present a significant challenge for ERAT due to the difficult removal of large, impacted fecal stones using conventional techniques. PATIENT CONCERNS: A 40-year-old male presented with persistent right lower quadrant pain, tenderness, and elevated inflammatory markers. DIAGNOSES: Abdominal computed tomography confirmed appendiceal dilation and a giant fecal stone, leading to a diagnosis of chronic appendicitis with a giant appendicolith. INTERVENTIONS: The patient underwent ERAT, during which electrohydraulic lithotripsy (EHL) was employed to fragment the large stone that was not amenable to direct extraction. OUTCOMES: ERAT combined with EHL successfully fragmented and removed the appendicolith, relieving the appendiceal obstruction. The patient's abdominal pain resolved promptly postoperatively, inflammatory markers normalized, and he was discharged on the second postoperative day. During a 12-month follow-up period, the patient remained asymptomatic, with follow-up imaging showing no signs of recurrence. LESSONS: ERAT combined with EHL is a safe and effective approach for managing chronic appendicitis with giant appendicoliths. This combined strategy overcomes the technical challenge of removing large, impacted stones via a minimally invasive, organ-preserving approach, avoiding the risks associated with surgical intervention. It represents a promising therapeutic alternative for these challenging cases.