|Synonyms||fecalith, fecolith, fecaloma, coprolith, stercolith|
|A fecolith marked by the arrow which has resulted in acute appendicitis.|
|Classification and external resources|
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. They can also obstruct diverticula.
- CT Scan
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 conditions
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. It may occur in chronic obstruction of stool transit, as in megacolon 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.
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 or proctocolectomy and ileostomy may be required only when all conservative measures of evacuation fail.
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.
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