Fecolith

Fecolith
Synonyms	fecalith, fecolith, fecaloma, coprolith, stercolith

A fecolith marked by the arrow which has resulted in acute appendicitis.
Pronunciation	fecaloma/fiːkəˈloʊmə/, "FEE-kə-LOH-mə
Classification and external resources
Specialty	gastroenterology
ICD-10	K38.1
ICD-9-CM	560.39

Fecolith, also called a fecaloma or faecaloma, is an extreme form of fecal impaction, often characterized by calcification. The term fecalith literally means a "stone" made of feces (lith=stone). It is a hardening of feces into lumps of varying size and may occur anywhere in the intestinal tract but is typically found in the colon. It is also called appendicolith when it occurs in the appendix and is sometimes concomitant with appendicitis.^[1] They can also obstruct diverticuli.

Features

Constipation

Diagnosis

CT Scan^[2]
Ultrasound

Causes

There are several causes of fecaloma and have been described in association with:

Hirschsprung's disease
patients suffering with chronic constipation
psychiatric patients
Chagas disease
both inflammatory and neoplastic conditons

Pathophysiology

As the fecal matter gradually stagnates and accumulates in the intestine, increase in volume occurs until the intestine becomes deformed and acquires characteristics similar to that of a tumor.^[3] It may occur in chronic obstruction of stool transit, as in megacolon^[4] and chronic constipation. Some diseases, such as Chagas disease, Hirschsprung's disease and others damage the autonomic nervous system in the colon's mucosa (Auerbach's plexus) and may cause extremely large or "giant" fecalomas, which must be surgically removed (disimpaction). Rarely, a fecalith will form around a hairball (Trichobezoar), or other hygroscopic or desiccant nucleus.

Treatment

Distal or sigmoid, fecalomas can often be disimpacted digitally or by a catheter which carries a flow of disimpaction fluid (water or other solvent or lubricant). Surgical intervention in the form of sigmoid colectomy^[5] or proctocolectomy and ileostomy^[6] may be required only when all conservative measures of evacuation fail.

Complications

Fecal impaction and attempts at removal can have severe and even lethal effects, such as the rupture of the colon wall by catheter or an acute angle of the fecaloma (stercoral perforation), followed by septicemia. A small fecalith is one cause of both appendicitis and acute diverticulitis. It may also lead to stercoral perforation, a condition characterized by bowel perforation due to pressure necrosis from a fecal mass or fecaloma.^[7]^[8]

Appendicolith as seen on CT
Appendicolith as seen on plain X ray

References

↑ Aljefri, A; Al-Nakshabandi, N (2008). "The stranded stone: relationship between acute appendicitis and appendicolith.". Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association. 15 (4): 258–60. doi:10.4103/1319-3767.56106. PMC 2981843. PMID 19794272.
↑ Fagelman, D; Warhit, JM; Reiter, JD; Geiss, AC (June 1984). "CT diagnosis of fecaloma.". Journal of computer assisted tomography. 8 (3): 559–61. doi:10.1097/00004728-198406000-00040. PMID 6725706.
↑ Yucel, AF; Akdogan, RA; Gucer, H (February 2012). "A giant abdominal mass: fecaloma.". Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 10 (2): e9–e10. doi:10.1016/j.cgh.2011.06.030. PMID 21749849.
↑ Rajagopal, A; Martin, J (June 2002). "Giant fecaloma with idiopathic sigmoid megacolon: report of a case and review of the literature.". Diseases of the colon and rectum. 45 (6): 833–5. doi:10.1007/s10350-004-6306-x. PMID 12072639.
↑ Garisto, JD; Campillo, L; Edwards, E; Harbour, M; Ermocilla, R (5 February 2009). "Giant fecaloma in a 12-year-old-boy: a case report.". Cases journal. 2 (1): 127. doi:10.1186/1757-1626-2-127. PMC 2642792. PMID 19196473.
↑ Altomare, DF; Rinaldi, M; Sallustio, PL; Armenise, N (March 2009). "Giant fecaloma in an adult with severe anal stricture caused by anal imperforation treated by proctocolectomy and ileostomy: report of a case.". Diseases of the colon and rectum. 52 (3): 534–7. doi:10.1007/DCR.0b013e318199db36. PMID 19333059.
↑ Kumar, P; Pearce, O; Higginson, A (January 2011). "Imaging manifestations of faecal impaction and stercoral perforation.". Clinical radiology. 66 (1): 83–8. doi:10.1016/j.crad.2010.08.002. PMID 21147303.
↑ Hsiao, TF; Chou, YH (January 2010). "Stercoral perforation of colon: a rare but important mimicker of acute appendicitis.". The American journal of emergency medicine. 28 (1): 112.e1–2. doi:10.1016/j.ajem.2009.02.024. PMID 20006219.

Diseases of the digestive system (primarily K20–K93, 530–579)

Upper GI tract

Esophagus	Esophagitis Candidal Eosinophilic Herpetiform Rupture Boerhaave syndrome Mallory-Weiss syndrome UES Zenker's diverticulum LES Barrett's esophagus Esophageal motility disorder Nutcracker esophagus Achalasia Diffuse esophageal spasm Gastroesophageal reflux disease (GERD) Laryngopharyngeal reflux (LPR) Esophageal stricture Megaesophagus

Stomach	Gastritis Atrophic Ménétrier's disease Gastroenteritis Peptic (gastric) ulcer Cushing ulcer Dieulafoy's lesion Dyspepsia Pyloric stenosis Achlorhydria Gastroparesis Gastroptosis Portal hypertensive gastropathy Gastric antral vascular ectasia Gastric dumping syndrome Gastric volvulus

Lower GI tract:
Intestinal/
Enteropathy

Small intestine (Duodenum/Jejunum/Ileum)	Enteritis Duodenitis Jejunitis Ileitis Peptic (duodenal) ulcer Curling's ulcer Malabsorption: Coeliac Tropical sprue Blind loop syndrome Small bowel bacterial overgrowth syndrome Whipple's Short bowel syndrome Steatorrhea Milroy disease Bile acid malabsorption

Large intestine (Appendix/Colon)	Appendicitis Colitis Pseudomembranous Ulcerative Ischemic Microscopic Collagenous Lymphocytic Functional colonic disease IBS Intestinal pseudoobstruction / Ogilvie syndrome Megacolon / Toxic megacolon Diverticulitis/Diverticulosis

Large and/or small	Enterocolitis Necrotizing Gastroenterocolitis IBD Crohn's disease Vascular: Abdominal angina Mesenteric ischemia Angiodysplasia Bowel obstruction: Ileus Intussusception Volvulus Fecal impaction Constipation Diarrhea Infectious Intestinal adhesions

Rectum	Proctitis Radiation proctitis Proctalgia fugax Rectal prolapse Anismus

Anal canal	Anal fissure/Anal fistula Anal abscess Anal dysplasia Pruritus ani

GI bleeding/BIS

Accessory

Liver	Hepatitis Viral hepatitis Autoimmune hepatitis Alcoholic hepatitis Cirrhosis PBC Fatty liver NASH Vascular Budd-Chiari syndrome Hepatic veno-occlusive disease Portal hypertension Nutmeg liver Alcoholic liver disease Liver failure Hepatic encephalopathy Acute liver failure Liver abscess Pyogenic Amoebic Hepatorenal syndrome Peliosis hepatis Metabolic disorders Wilson's disease Hemochromatosis

Gallbladder	Cholecystitis Gallstones/Cholecystolithiasis Cholesterolosis Rokitansky-Aschoff sinuses Postcholecystectomy syndrome Porcelain gallbladder

Bile duct/ Other biliary tree	Cholangitis Primary sclerosing cholangitis Secondary sclerosing cholangitis Ascending Cholestasis/Mirizzi's syndrome Biliary fistula Haemobilia Gallstones/Cholelithiasis Common bile duct Choledocholithiasis Biliary dyskinesia Sphincter of Oddi dysfunction

Pancreatic	Pancreatitis Acute Chronic Hereditary Pancreatic abscess Pancreatic pseudocyst Exocrine pancreatic insufficiency Pancreatic fistula

Abdominopelvic

Hernia	Diaphragmatic Congenital Hiatus Inguinal Indirect Direct Umbilical Femoral Obturator Spigelian Lumbar Petit's Grynfeltt-Lesshaft Undefined location Incisional Internal hernia Richter's

Peritoneal	Peritonitis Spontaneous bacterial peritonitis Hemoperitoneum Pneumoperitoneum

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