Endoscopy 2019; 51(10): 994-995
DOI: 10.1055/a-0889-7289
E-Videos
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic transcecal appendectomy

Xiang-lei Yuan*
1  Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
,
Onpan Cheung*
2  San Bernardino Gastroenterology Associates, Rialto, California, USA
,
Jiang Du
1  Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
,
Lian-song Ye
1  Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
,
Bing Hu
1  Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
› Author Affiliations
Further Information

Corresponding author

Bing Hu, MD
Department of Gastroenterology
West China Hospital, Sichuan University
No. 37 Guo Xue Xiang
Wu Hou District, Chengdu
Sichuan 610041
China   
Fax: +86-028-85423387   

Publication History

Publication Date:
16 May 2019 (online)

 

A 53-year-old woman was referred to our hospital after a 1-cm submucosal bulge near the appendiceal orifice ([Fig. 1]) was incidentally found during a colonoscopy. The patient was asymptomatic. Her past medical history was significant only for acute appendicitis 20 years previously; she had suffered no complications, and had recovered fully with only conservative management. Endoscopic ultrasonography showed a hypoechoic lesion with an homogeneous echo, originating from the muscularis propria ([Fig. 2]).

Zoom Image
Fig. 1 Colonoscopy revealed a 1-cm submucosal bulge near the appendiceal orifice in an asymptomatic 53-year-old woman with a history of acute appendicitis 20 years previously.
Zoom Image
Fig. 2 Endoscopic ultrasonography showed a hypoechoic lesion with an homogeneous echo, originating from the muscularis propria.

Since the lesion involved the appendix, endoscopic transcecal appendectomy was performed to obtain an accurate diagnosis. After submucosal injection of sodium hyaluronate mixed with adrenaline, an initial mucosal incision was made using a dual knife (Olympus), followed by full-thickness dissection. Next, circumferential dissection was continued along the outer surface of the appendix with an insulated-tip knife (IT2 knife; Olympus) and the dual knife, and this process eventually separated the appendix from the mesoappendix ([Fig. 3]). Under colonoscopic view, a 20-mL syringe with an 18-gauge needle was punctured into the abdominal cavity to release excess air. The completely resected appendix was pulled into the colon and was retrieved using a snare ([Fig. 4]). The defect was closed with endoloops and clips using the pursestring suture technique. The total procedure time was 90 minutes. Pathological examination confirmed chronic appendicitis. The patient was discharged 3 days later without complications. Follow-up colonoscopy was done at 1 month and showed the healing of the resection site ([Fig. 5]). No delayed complications were noted.

Zoom Image
Fig. 3 The appendix was successfully separated from the mesoappendix.
Zoom Image
Fig. 4 The resected appendix and lesion, measuring 5.5 × 2.0 cm.
Zoom Image
Fig. 5 Postoperative colonoscopy 1 month later showed the healing of the resection site, and residual endoloops and clips.

Video 1 Endoscopic transcecal appendectomy in a 53-year-old woman.


Quality:

Transvaginal and transgastric appendectomy have been reported in humans [1] [2], and these techniques generally require a hysteroscopy or laparoscopy. We present here a successful case of transcecal appendectomy via a colonoscopic approach. This method with no skin incision appears to be a good and promising option for treating appendiceal diseases. Further clinical studies with larger samples and long-term follow-up are needed to validate and assess its safety.

Endoscopy_UCTN_Code_TTT_1AQ_2AJ

Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high
quality video and all contributions are
freely accessible online.
This section has its own submission
website at
https://mc.manuscriptcentral.com/e-videos


#

Competing interests

All authors state they have no conflicts of interest relevant to this article.

Acknowledgment

The authors acknowledge funding support from Sichuan Province Science and Technology Department (China) (2017SZ0009).

* Co-first authors.



Corresponding author

Bing Hu, MD
Department of Gastroenterology
West China Hospital, Sichuan University
No. 37 Guo Xue Xiang
Wu Hou District, Chengdu
Sichuan 610041
China   
Fax: +86-028-85423387   


Zoom Image
Fig. 1 Colonoscopy revealed a 1-cm submucosal bulge near the appendiceal orifice in an asymptomatic 53-year-old woman with a history of acute appendicitis 20 years previously.
Zoom Image
Fig. 2 Endoscopic ultrasonography showed a hypoechoic lesion with an homogeneous echo, originating from the muscularis propria.
Zoom Image
Fig. 3 The appendix was successfully separated from the mesoappendix.
Zoom Image
Fig. 4 The resected appendix and lesion, measuring 5.5 × 2.0 cm.
Zoom Image
Fig. 5 Postoperative colonoscopy 1 month later showed the healing of the resection site, and residual endoloops and clips.