Calcified Appendiceal Phytobezoar Associated With Complicated Acute Appendicitis: A Case Report

An appendiceal phytobezoar is an uncommon intraluminal aggregate of indigestible plant material that may resemble a conventional appendicolith when calcified. We describe a 34-year-old woman who presented after approximately one day of severe right lower quadrant abdominal pain accompanied by nausea and vomiting. She was afebrile and hemodynamically stable but had localized peritoneal signs and neutrophilic leukocytosis. Plain radiographs showed a right lower quadrant radiopacity, and noncontrast computed tomography demonstrated a large appendiceal calcification with surrounding inflammatory changes. Emergency laparoscopy revealed a markedly enlarged, inflamed appendix and a localized purulent collection adjacent to an anatomically intact appendiceal base. Adhesiolysis and drainage of the collection were followed by laparoscopic appendectomy, securing the stump with two endoloops. The specimen measured 7.0 cm in length and 3.5 cm in maximum diameter and contained a 1.7 × 1.2 cm intraluminal concretion. Histopathology established suppurative and necrotizing acute appendicitis with ulceration and identified the concretion as a phytobezoar composed of vegetable fibers and dystrophic calcification. A Blake drain was removed on postoperative day 7 after drain output had ceased; subsequent follow-up remained favorable. This case illustrates the diagnostic limitation of labeling every calcified appendiceal concretion a fecalith and the value of radiologic-operative-pathologic correlation in symptomatic patients with apparently rapid progression to complicated appendicitis.