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. 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. EndoscopyUCTNCodeCCL₁AD₂AJ EndoscopyUCTNCodeTTT₁AQ₂AJ 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
Zou et al. (2026) studied this question.