Appendicolith

Last revised by Dr Michael P Hartung on 09 Nov 2022

An appendicolith is a calcified deposit within the appendix. They are present in a large number of children with acute appendicitis and may be an incidental finding on an abdominal radiograph or CT. Incidence may be increased among patients with a retrocecal appendix. Overall they are seen in 10% of patients, with 90% subsequently going on to develop appendicitis 3.

Although the cause of appendicolith formation is uncertain, some case reports have mentioned an ingested foreign body or a dislodged gallstone eroding through the gallbladder as possible etiologies. 

If identified on ultrasound, an appendicolith will appear cast an acoustic shadow. On abdominal radiograph or CT, a high attenuation stone may be seen in the right iliac fossa. CT is more sensitive than plain film. Up to 25% show laminated calcification.

During the Covid-19 pandemic, there has been an increase in conservative management of appendicitis, due to the risk of aerosol generation during anesthesia and laparoscopy 4. However, the presence of an appendicolith in the context of acute appendicitis is associated with failure of conservative management and increase in complications 5.

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Cases and figures

  • Figure 1: gross specimen
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  • Case 1: CT
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  • Case 2: on abdominal radiograph
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  • Case 3: ultrasound
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  • Case 4: appendicolith
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  • Case 5: appendicitis and giant appendicolith
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  • Case 6
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  • Case 7: acute appendicitis with appendicolith
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  • Case 8: extraluminal - perforated appendix
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  • Case 9: acute appendicitis with appendicolith
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  • Case 10
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