Endoscopic clip-induced acute appendicitis in a patient on chronic hemodialysis: a case report with literature review

Abstract Background Foreign body-induced acute appendicitis is rare but could most often be caused by fish bones; those caused by endoscopic clips are highly rare. Herein, we report a case of acute appendicitis caused by endoscopic clips that developed 2 years after the endoscopic procedure. Case presentation A 68-year-old man with a 2-year history of hemodialysis (HD) for diabetic nephropathy visited our hospital with pain in the right lower quadrant. He had undergone endoscopic submucosal dissection (ESD) for gastric adenoma 2 years earlier. Abdominal computed tomography revealed acute gangrenous appendicitis and a high-density structure lodged in the appendix. This structure was determined to be an endoscopic clip that was lodged in the patient’s appendix for 2 years. The patient underwent an emergency laparoscopic appendectomy, and an endoscopic clip covered by a fecalith was found in the appendix. Conclusion Endoscopic clips usually fall off spontaneously in approximately a week and pass through stool. However, in this case, appendicitis developed 2 years after the ESD. An emergency surgical appendectomy may be recommended for appendicitis caused by foreign bodies. Prophylactic appendectomy or removal of foreign bodies should be considered for HD patients, even in the absence of symptoms owing to the potential severity of appendicitis in such patients.