Endoscopic retrograde appendiceal irrigation for children with recurrent abdominal pain and appendiceal fecaliths: a retrospective cohort study.

BACKGROUND

Recurrent abdominal pain (RAP) in children with appendiceal fecaliths and mesenteric lymphadenitis poses a diagnostic and therapeutic challenge, often mimicking appendicitis. The role of interventional endoscopy in this setting is undefined.

METHODS

We retrospectively analyzed children with RAP, sonographically confirmed appendiceal fecaliths, and ileocecal lymphadenitis who underwent ultrasound-guided endoscopic retrograde appendiceal irrigation (ERAI) from 2021 to 2023. Technical success, complications, immediate symptom resolution, and follow-up outcomes were assessed.

RESULTS

Totally, 73 patients (mean age 8.3 years) who underwent successful ERAI (100% technical success) were included in this study for safety analysis. Three were lost to follow-up, leaving 70 for efficacy analysis. Immediate pain resolution was reported in 98.6% (69/70) of patients with follow-up. Minor complications such as self-limiting bleeding and procedure-related discomfort occurred in 8.2% (6/73) and 9.6% (7/73) of patients, respectively. There were no perforations or major adverse events. During a median follow-up of 15.5 months, the abdominal pain recurrence rate was 18.6%. The sonographic prevalence of mesenteric lymphadenitis decreased significantly from 100% preoperatively to 21.9% postoperatively (p<0.01).

CONCLUSIONS

ERAI appears to be a feasible and safe super-minimally invasive procedure for selected children with RAP associated with appendiceal fecaliths and lymphadenitis, and was associated with rapid symptomatic relief and a significant reduction in lymphadenitis.