Choledochoscope Removal of a Sharp Appendiceal Foreign Body

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A 73-year-old man presented 3 days after accidental ingestion of a root canal file during endodontic treatment, accompanied by 3 hours of right lower quadrant pain. Laboratory tests were unremarkable. Abdominal computed tomography (Figure 1a) revealed appendiceal wall thickening, a 2.7 cm linear hyperdense intraluminal opacity, periappendiceal fat stranding, and no radiologic evidence of perforation.Figure 1.: (a) Abdominal computed tomography showed an appendiceal foreign body and no evidence of perforation. (b) The root canal file was removal using a biopsy forceps. (c) The removed root canal file.Colonoscopy demonstrated a normal appendiceal orifice. A flexible video choledochoscope was advanced into the appendiceal lumen under direct visualization (Video 1), and the sharp foreign body was securely removal using biopsy forceps (Figure 1b). The removed instrument measured 3.5 cm in length with a sharp tip (Figure 1c). The patient's symptoms resolved rapidly after the procedure, and he was discharged uneventfully with no adverse events. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1","caption":"Choledochoscope removal of a sharp appendiceal foreign body","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_1jxff5l1"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Appendiceal foreign bodies are an uncommon cause of acute appendicitis, whereas sharp foreign bodies are even rarer and carry a high risk of perforation. Surgical appendectomy remains the traditional standard of care, even as a prophylactic measure for non-perforated sharp foreign bodies. This novel minimally invasive approach achieves complete retrieval of a long, sharp appendiceal foreign body while obviating operative resection. In appropriately selected nonperforated cases, direct choledochoscope-guided extraction represents a safe and effective alternative to conventional surgery, highlighting innovative endoscopic crossover application in the appendix. Watch the video at XXX. (Informed consent was obtained from the patient to publish these images.)

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