Video of the month: crowbar endoscopic enucleation of a giant appendicolith.

A 70-year-old man affected with chronic heart failure presented at our institute with a recent history of right-lower-quadrant abdominal discomfort and elevated white blood cell count. In an exploratory colonoscopy, an embedded fecalith was visible through the appendiceal orifice of the cecum, and was surrounded by slightly hyperemic and edematous mucosa (left). A closed-forceps biopsy (Radial Jaw 4; Boston Scientific) was used in a crowbar fashion to enucleate the appendicolith. Once it became completely visible in the colonic lumen, the giant appendicolith was measured at about 3 cm in diameter. The underlying mucosa was hyperemic and covered with a small amount of pus (right). The patient’s symptoms and blood counts improved over the following days, and no adverse events were recorded.