Electrohydraulic lithotripsy-assisted endoscopic retrograde appendicitis therapy for a giant appendiceal fecalith

A 57-year-old woman complained of recurrent pain and tenderness in the right lower quadrant for 3 months. An abdominal computed tomographic scan revealed appendicitis and a giant appendiceal fecalith (2.5 × 3 cm; [ Fig. 1 ] a ). Therefore, the patient was admitted to remove the fecaliths by endoscopic retrograde appendicitis therapy (ERAT). The EyeMax subscope (Micro-Tech, Nanjing, China) was intubated into the appendiceal cavity, and found a giant appendicolith measuring approximately 3cm obstructing the appendiceal lumen ([ Fig. 1 ] b ). Unfortunately, it was unsuccessful to remove the appendicolith using a basket. Subsequently, it was decided to perform electrohydraulic lithotripsy (EHL) to break the appendicolith and success the removal of them ([ Fig. 1 ] c, d and [ Video 1 ]). After this, a 5 Fr-5cm Single Pigtail Stent was successfully implanted ([ Fig. 1 ] e ). Excitingly, the patient was recovered quickly from abdominal pain and was discharged 2 days later. Fig. 1 a An abdominal CT scan revealed appendicitis and a giant appendiceal fecalith. b A giant appendicolith was found by the EyeMax subscope in the appendiceal lumen. c Electrohydraulic lithotripsy (EHL) was performed to break the appendicolith. d The appendicolith was successfully removed. e A 5 Fr-5cm Single Pigtail Stent was successfully implanted. CT, computed tomography. Download Video The procedure of electrohydraulic lithotripsy-assisted endoscopic retrograde appendicitis therapy for a giant appendiceal fecalith.Video 1 ERAT presents a pioneering strategy in the management of appendicoliths, as a groundbreaking minimally invasive procedure specifically conceived to alleviate appendiceal obstruction [ 1 ] [ 2 ]. Appendicoliths are usually dimensionally less than 1 cm, with those larger than 2 cm designated as giant appendicoliths [ 3 ]. However, it is difficult to remove the giant appendicoliths by traditional strategies, such as basket, balloon, etc. In this case, electrohydraulic lithotripsy-assisted ERAT successfully removed a giant appendiceal fecalith, which maybe a promising approach in the administration of giant appendicoliths in the future. Endoscopy_UCTN_Code_CCL_1AD_2AJ Endoscopy_UCTN_Code_TTT_1AQ_2AJ Publication History Article published online: 17 February 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany