Post written by Ghassan M. Hammoud, MD, MPH, from the Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, Missouri, USA.

The cecum is cleansed and irrigated with water thoroughly. The inverted appendix is captured at its base with endoscopic detachable snares. We used 3detachable snares to ensure sufficient closure of the appendiceal lumen and capturing the appendiceal artery to prevent delayed bleeding or reversion of the appendiceal lumen back to its normal position after resection. Careful placement of the detachable snares is important as not to capture the cecal wall during this process. Endoscopic resection was performed above the detachable snares using blended current Endocut Q, Effect 3. To prevent delayed dehiscence, we placed an over the scope clip and retrieved the appendix.

This case illustrates the safe technique of endoscopic resection of symptomatic large inverted appendix using detachable snares and over-the-scope clip to avoid delayed bleeding and/or dehiscence of the appendiceal lumen after resection. It also alerts providers on possible unexplained causes of intermittent right lower-quadrant abdominal pain.

Endoscopic resection of large symptomatic inverted appendix is feasible and safe using the appropriate technique to avoid delayed bleeding or dehiscence. Patient should be informed and counseled on the risks and alternatives of surgical versus endoscopic management of long intussuscepted appendix.

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