Appendix Stones (Appendicolith): Incidence, Causes, Symptoms, & treatment.

What are appendix stones (appendicolith)?

Appendix stones are hard or calcified masses found inside the appendix. They can be found inside your appendix without any symptoms. However, they can obstruct the appendix and trigger appendicitis.

Moreover, patients with appendicitis with stones are at higher risk of complications such as appendicular abscess, appendicular gangrene, and burst appendix.

How common are appendix stones?

Due to the widespread use of advanced abdominal imaging such as Computed Tomography (CT), Appendix stones are frequently seen nowadays.

Appendix stones are common. Appendix stones affect about 4.4% of people in general. In patients with appendicitis, appendix stones are found in 38.7% of the cases (reference).

How common are complications with a stone appendix?

In this study, The presence of stones with appendicitis increased the risk of complications. In addition, appendix obstruction, the severity of inflammation, and perforation of the appendix were higher in patients with stone-related appendicitis.

The stone may escape the appendix after the perforation.

How are appendix stones formed (causes)?

Trapped stool mass.

ِAppendix stones are often due to a dense old stool mass trapped in the appendix. As time passes, the stool matter becomes more dense and dry. Also, minerals (such as calcium) deposit in the stool mass, making it harder.

According to one study, trapped stool masses (fecalith) are found in 3% of the population. The fecalith is the nidus for appendix stones (appendicolith).

Low-fiber diet.

A low fiber diet leads to hard stools, in research by dr. Jones and his team, A low-fiber diet is a risk factor of a fecalith in the appendix (which causes appendix stones).

Other causes.

Currently, we don’t fully understand the exact process and cause of the stone appendix. Other theories of stone appendix include:

• Trapped foreign bodies.
• Fruit seeds.
• Dislodged gallstone traveling through the small intestine to settle in the appendix.

Symptoms of appendix stones.

Appendix stones are found in about 4.4% of all people. However, most people have no symptoms. Appendix stones can also present with right lower abdominal pain that comes and goes.

Moreover, it increases the risk of acute appendicitis and its complications. For example, one study estimated that 30% of patients with appendix stones would develop appendicitis (reference).

The incidence of complications is also higher. For example, appendix obstruction, severe inflammation, and perforated appendicitis were more common with appendix stones than stone-free appendicitis (reference).

The following are possible symptoms and signs of appendicitis:

• No symptoms at all (commonest scenario).
• Recurrent abdominal pain at the lower right abdomen (similar to a right ureter stone).
• Acute appendicitis: the typical symptoms of acute appendicitis are explained separately below.
• Higher rate of appendix obstruction with acute appendicitis.
• Higher rate of burst appendix with acute appendicitis.
• Higher rate of other complications such as appendicular abscess and appendix gangrene.

Symptoms of acute appendicitis:

• It starts with mild abdominal pain around the umbilicus (belly button).
• Within hours, the inflammation of the umbilicus irritates the peritoneum over it (the peritoneum is a thin layer that envelopes most of the abdominal organs). When the peritoneum becomes irritated, the pain localizes in the lower right abdomen.
• The pain starts mild and may come and go. Soon, it becomes more severe, constant, and localizes.
• Nausea and anorexia follow the onset of pain (pain is the first sign).
• The pain doesn’t improve with defecation (unlike the pain from IBS and gastroenteritis).
• Severe tenderness and gardening over the area of pain.
• Fever (in 40% of the cases).
• Diarrhea or constipation.
• Generalized fatigue (malaise).
• Sometimes, urinary frequency or urgency.

How are appendix stones diagnosed?

Appendix stones can be detected by radiological techniques or visualized during the appendectomy operation. However, abdominal CT is the most accurate method of diagnosis of appendix stones (appendicolith) (reference).

Standard radiological techniques used for the diagnosis of appendix stones are:

• Abdominal Ultrasonography.
• Abdominal Computed Tomography (CT): the most sensitive method.
• Abdominal X-ray in the erect position (when it is sufficiently calcified).

Treatment of appendix stones.

Appendix stones without appendicitis are left without treatment. The current research doesn’t support the removal of appendix stones unless they cause complications.

If appendix stones cause appendicitis or any of its complications, urgent appendectomy with stone removal and the appendix is the only and best treatment.

Immediately call your doctor or go to the ER if you’ve appendix stone and developed appendicitis symptoms. The incidence of complications is higher, and early treatment is the best way to avoid it.