Acute appendicitis with four appendicoliths: a first case report in the English literature

This is an extremely rare presentation of multiple appendicoliths in one appendix. Multiple appendicoliths as well as appendicoliths larger than 5 mm have been implicated in severe appendicitis as well as perforation and gangrene of the appendix. There is no known correlation with appendicular malignancy. The controversy arises in the surgical management of asymptomatic patients. There is emerging evidence that justifies an elective appendicectomy in asymptomatic patients.