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Abstract
An appendicolith is defined as a calcified mass within the lumen of the appendix formed by the aggregation of fecal particles and inorganic salts.[1] Appendicolith can present with varied clinical features. With the advent of MDCT, the incidental identification of appendicolith in asymptomatic patients has increased in its prevalence. However, in a case series by Ranieri D et al., an appendicolith obstructing the lumen of the appendix, causing appendicitis was found in the CT scans of 38.7% of patients presenting with acute abdomen as suspected appendicitis.[2] Appendicitis, which is caused by appendicolith, is more commonly associated with perforation and abscess formation.[3] Appendicolith with appendicitis usually presents with intermittent right lower quadrant pain, rebound tenderness and fever.[4] But an appendicolith presenting as right upper quadrant pain mimicking a gallstone disease is a rare presentation.
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References
- Babington EA. Appendicoliths, the little giants: a narrative review. Radiography 2022;29(1):1-7. DOI: https://doi.org/10.1016/j.radi.2022.09.006
- Ranieri DM, Enzerra MD, Pickhardt PJ. Prevalence of appendicoliths detected at CT in adults with suspected appendicitis. Am J Roentgenol 2021;216(3):677-82. DOI: https://doi.org/10.2214/AJR.20.23149
- Taib A, Kler A, Prayle M, et al. Appendicolith appendicitis: should we be operating sooner? A retrospective cohort study. Ann R Coll Surg Engl 2023;106(3):237-44. DOI: https://doi.org/10.1308/rcsann.2023.0055
- Kaya B, Eris C. Different clinical presentation of appendicolithiasis. The report of three cases and review of the literature. Clinical Medicine Insights Pathology 2011;4:CPath-S6757. DOI: https://doi.org/10.4137/CPath.S6757
- Han H, Letourneau ID, Abate YH, et al. Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the Global Burden of Disease Study 2021. The Lancet Gastroenterol Hepatol 2024;9(9):825–58. DOI: https://doi.org/10.1016/S2468-1253(24)00157-2
- Lotfollahzadeh S, Lopez RA, Deppen JG. Appendicitis. Treasure Island (FL): StatPearls Publishing 2025. https://www.ncbi.nlm.nih.gov/books/NBK493193/
- Narula N, Gibbs KE, Kong F, et al. Appendiceal intussusception, diverticula, and fecalith associated with appendicitis. Am Surg 2022;89(12):6257–9. DOI: https://doi.org/10.1177/00031348221126954
- Prieto JM, Wang AW, Halbach J, et al. Elemental, fatty acid, and protein composition of appendicoliths. Sci Rep 2022;12(1). DOI: https://doi.org/10.1038/s41598-022-21397-9
- Fitz RH. Perforating inflammation of the vermiform appendix: with special reference to its early diagnosis and treatment. Vol. 1. Philadelphia: Wm. J. Dornan Printer 1886.
- Paya K, Treitl C, Barousch A, et al. Kotsteine und Appendektomieim Kindesalter. European Surgery 2008;40(1):27–9. DOI: https://doi.org/10.1007/s10353-007-0376-7
- Kaewlai R, Wongveerasin P, Lekanamongkol W, et al. CT of appendicoliths in adult appendicitis: clinical significance and characteristics of overlooked cases. Eur Radiol 2023;34(4):2534-45. DOI: https://doi.org/10.1007/s00330-023-10273-3
- Mällinen J, Vaarala S, Mäkinen M, et al. Appendicolith appendicitis is clinically complicated acute appendicitis- is it histopathologically different from uncomplicated acute appendicitis. Int J Colorectal Dis 2019;34(8):1393-400. DOI: https://doi.org/10.1007/s00384-019-03332-z
- Laméris W, Van Randen A, Go PM, et al. Single and combined diagnostic value of clinical features and laboratory tests in acute appendicitis. Acad Emerg Med 2009;16(9):835-42. DOI: https://doi.org/10.1111/j.1553-2712.2009.00486.x
- Di Saverio S, Podda M, De Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg 2020;15(1):27. DOI: https://doi.org/10.1186/s13017-020-00306-3
- AlJohani M, AlSulaim L, AlHarbi A, et al. Accuracy of diagnostic modalities in suspected appendicitis in King Saud Hospital, Unaizah, Qassim, Saudi Arabia-retrospective cohort study. Int J Surg Open 2022;47:100553. DOI: https://doi.org/10.1016/j.ijso.2022.100553
- Mahajan P, Basu T, PaiC, et al. Factors associated with potentially missed diagnosis of appendicitis in the emergency department. JAMA Network Open 2020;3(3):e200612. DOI: https://doi.org/10.1001/jamanetworkopen.2020.0612
- Patel NR, Lakshman S, Hays TV, et al. Subhepatic appendix with fecalith mimicking acute cholecystitis with gallstone. JClin Ultrasound 1996;24(1):45-7. DOI: https://doi.org/10.1002/(SICI)1097-0096(199601)24:1<45::AID-JCU9>3.0.CO;2-L
- Teke Z, Kabay B, Erbiş H, et al. Appendicolithiasis causing diagnostic dilemma: a rare cause of acute appendicitis (report of a case). Ulus Travma Acil Cerrahi Derg 2008;14(4):323-5.
- Athawale HR, Vageriya N, Dhende NP, et al. Giant appendicolith mimicking as foreign body: a case report. J Pediatric Surg Case Rep 2016;4:54-7. DOI: https://doi.org/10.1016/j.epsc.2015.11.005
References
Babington EA. Appendicoliths, the little giants: a narrative review. Radiography 2022;29(1):1-7. DOI: https://doi.org/10.1016/j.radi.2022.09.006
Ranieri DM, Enzerra MD, Pickhardt PJ. Prevalence of appendicoliths detected at CT in adults with suspected appendicitis. Am J Roentgenol 2021;216(3):677-82. DOI: https://doi.org/10.2214/AJR.20.23149
Taib A, Kler A, Prayle M, et al. Appendicolith appendicitis: should we be operating sooner? A retrospective cohort study. Ann R Coll Surg Engl 2023;106(3):237-44. DOI: https://doi.org/10.1308/rcsann.2023.0055
Kaya B, Eris C. Different clinical presentation of appendicolithiasis. The report of three cases and review of the literature. Clinical Medicine Insights Pathology 2011;4:CPath-S6757. DOI: https://doi.org/10.4137/CPath.S6757
Han H, Letourneau ID, Abate YH, et al. Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the Global Burden of Disease Study 2021. The Lancet Gastroenterol Hepatol 2024;9(9):825–58. DOI: https://doi.org/10.1016/S2468-1253(24)00157-2
Lotfollahzadeh S, Lopez RA, Deppen JG. Appendicitis. Treasure Island (FL): StatPearls Publishing 2025. https://www.ncbi.nlm.nih.gov/books/NBK493193/
Narula N, Gibbs KE, Kong F, et al. Appendiceal intussusception, diverticula, and fecalith associated with appendicitis. Am Surg 2022;89(12):6257–9. DOI: https://doi.org/10.1177/00031348221126954
Prieto JM, Wang AW, Halbach J, et al. Elemental, fatty acid, and protein composition of appendicoliths. Sci Rep 2022;12(1). DOI: https://doi.org/10.1038/s41598-022-21397-9
Fitz RH. Perforating inflammation of the vermiform appendix: with special reference to its early diagnosis and treatment. Vol. 1. Philadelphia: Wm. J. Dornan Printer 1886.
Paya K, Treitl C, Barousch A, et al. Kotsteine und Appendektomieim Kindesalter. European Surgery 2008;40(1):27–9. DOI: https://doi.org/10.1007/s10353-007-0376-7
Kaewlai R, Wongveerasin P, Lekanamongkol W, et al. CT of appendicoliths in adult appendicitis: clinical significance and characteristics of overlooked cases. Eur Radiol 2023;34(4):2534-45. DOI: https://doi.org/10.1007/s00330-023-10273-3
Mällinen J, Vaarala S, Mäkinen M, et al. Appendicolith appendicitis is clinically complicated acute appendicitis- is it histopathologically different from uncomplicated acute appendicitis. Int J Colorectal Dis 2019;34(8):1393-400. DOI: https://doi.org/10.1007/s00384-019-03332-z
Laméris W, Van Randen A, Go PM, et al. Single and combined diagnostic value of clinical features and laboratory tests in acute appendicitis. Acad Emerg Med 2009;16(9):835-42. DOI: https://doi.org/10.1111/j.1553-2712.2009.00486.x
Di Saverio S, Podda M, De Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg 2020;15(1):27. DOI: https://doi.org/10.1186/s13017-020-00306-3
AlJohani M, AlSulaim L, AlHarbi A, et al. Accuracy of diagnostic modalities in suspected appendicitis in King Saud Hospital, Unaizah, Qassim, Saudi Arabia-retrospective cohort study. Int J Surg Open 2022;47:100553. DOI: https://doi.org/10.1016/j.ijso.2022.100553
Mahajan P, Basu T, PaiC, et al. Factors associated with potentially missed diagnosis of appendicitis in the emergency department. JAMA Network Open 2020;3(3):e200612. DOI: https://doi.org/10.1001/jamanetworkopen.2020.0612
Patel NR, Lakshman S, Hays TV, et al. Subhepatic appendix with fecalith mimicking acute cholecystitis with gallstone. JClin Ultrasound 1996;24(1):45-7. DOI: https://doi.org/10.1002/(SICI)1097-0096(199601)24:1<45::AID-JCU9>3.0.CO;2-L
Teke Z, Kabay B, Erbiş H, et al. Appendicolithiasis causing diagnostic dilemma: a rare cause of acute appendicitis (report of a case). Ulus Travma Acil Cerrahi Derg 2008;14(4):323-5.
Athawale HR, Vageriya N, Dhende NP, et al. Giant appendicolith mimicking as foreign body: a case report. J Pediatric Surg Case Rep 2016;4:54-7. DOI: https://doi.org/10.1016/j.epsc.2015.11.005