Digital single-operator cholangioscopy-guided appendiceal intubation for endoscopic retrograde appendicitis therapy in a pregnant woman (with video)

A pregnant woman with persistent right lower abdominal pain underwent US of the appendix and received a diagnosis of acute appendicitis with fecal stone incarceration. After a multidisciplinary discussion, endoscopic retrograde appendicitis treatment (ERAT) with the use of a digital single-operator cholangioscopy system was performed. After the transparent cap-covered colonoscope was advanced into the cecum and adjusted to face Gerlach’s valve, and the orifice of the appendix was immersed under water, a single-operator cholangioscope was gently and directly intubated into the appendix lumen without a guidewire (A) (Video 1, available at www/giejournal.org.). Under direct vision, the cholangioscope was successfully maneuvered into the appendiceal cavity, and several incarcerated fecal masses were clearly observed (B). Then the appendix lumen was flushed with saline continuously under cholangioscopic direct vision. After the fecal masses were completely washed out through the appendiceal orifice (C), the clean appendix lumen was confirmed by cholangioscopy (D), and mucosal hyperemia, edema, and erosion in the appendiceal cavity were also observed. The patient’s abdominal pain was significantly relieved, and she was discharged from the hospital without using antibiotics.