Harbin hospital treats fecalith-related appendicitis with direct-vision ERAT

Harbin Medical University’s Fourth Hospital reported on 23 October 2026 that its gastroenterology team had treated a patient with fecalith-related appendicitis using direct-vision endoscopic retrograde appendicitis therapy, or ERAT. The account describes an organ-preserving option for a patient whose condition was assessed as suitable; the appendix was not removed.

Assessment before choosing treatment

The patient initially experienced swelling and pain in the lower right abdomen. Rest brought some relief, but the pain returned over the following days. An examination at another hospital found a fecalith in the appendix and led to a recommendation for appendectomy. Concerned about an abdominal scar and recovery time, she sought an assessment from Wang Liguo’s team at the hospital’s gastroenterology clinic.

The team reviewed her history and completed a physical examination and imaging assessment. It diagnosed uncomplicated appendicitis caused by an impacted fecalith and judged that she met the indications for ERAT. After discussing the findings and treatment plan with the patient, the clinicians chose an approach that addressed the obstruction while retaining the appendix.

Two endoscopes and direct observation

With support from anesthesia clinicians and specialist endoscopy nurses, the team passed a colonoscope through the anus to the ileocecal region and located the appendiceal opening. A thin secondary endoscope was advanced through the working channel into the appendix, allowing the team to examine the inside directly.

The lining showed mild congestion and swelling, and granular fecalith material was partly blocking the lumen. Under direct vision, the team repeatedly irrigated the appendix with saline and used negative-pressure suction to remove inflammatory secretions and small fecaliths, restoring patency. The procedure was completed smoothly, with stable vital signs and no obvious pain or discomfort reported during the intervention.

The hospital reported that abdominal pain had eased markedly on the same day and that the patient could get out of bed and walk independently. There was no surgical incision on the abdominal surface. These are the immediate results described in this case; the report does not give a longer follow-up interval.

A consultation about suitability

The hospital explains that direct-vision ERAT combines assessment of the inflammation and cause of obstruction with treatment such as fecalith removal and drainage. It uses the natural digestive tract and preserves the appendix rather than removing it through an open or laparoscopic operation.

For a patient considering care in Harbin, the useful detail is the documented clinical pathway: gastroenterology assessment, physical and imaging evaluation, confirmation of uncomplicated disease and procedural suitability, followed by discussion of the treatment plan. The reported outcome concerns this selected patient and does not establish that the same approach suits every episode of appendicitis.