Laparoscopic surgery assisted by colonoscopy for a submucosal cecal fecalith presenting as acute appendicitis: A case report

Appendiceal Fecalith Presenting as a Submucosal Cecal Polyp Removed During Colonoscopy

Appendiceal fecaliths, also known as stercoliths or coproliths, are rigid masses comprised of fecal material that become lodged within the appendix. They are generally accepted to be a primary etiologic agent of acute appendicitis and appendiceal intussusception in adults. We report a case of an asymptomatic woman undergoing colonoscopy found to have a submucosal appearing mass below the appendiceal orifice. A neoplastic appearing lesion on the orifice of the appendix was resected, after which a fecalith extruded into the colonic lumen. This is the first reported case of appendiceal fecalith discovered and completely removed during colonoscopy in an asymptomatic patient.

Appendicitis with submucosal fecalith mimicking a submucosal tumor: a case report

Background

Submucosal fecalith(s) mimicking submucosal tumors of the gastrointestinal lumen are rare. Moreover, accurate preoperative diagnosis of these entities is exceedingly difficult, and the mechanism(s) of their formation remains unclear.

Case presentation

A 40-year-old woman visited the authors’ hospital due to lower abdominal pain and diarrhea. She had previously been treated for endometriosis. Laboratory investigation revealed increased C-reactive protein levels. Abdominal contrast-enhanced computed tomography revealed thickening of the appendix wall and dilation of the small intestine. The patient was diagnosed with paralytic ileus caused by appendicitis, and interval appendectomy was scheduled. She underwent laparoscopic-assisted appendectomy after conservative treatment. Partial cecal resection was selected due to the presence of an elastic mass in the cecum. The final pathological diagnosis was submucosal fecalith, not submucosal tumor. On day 5, the patient was discharged without any postoperative complications.

Conclusions

In cases of appendicitis with fecalith(s) that appear as submucosal tumor(s) on colonoscopy, submucosal fecalith mimicking submucosal tumor should be considered in the differential diagnosis.

Submucosal Fecalith Presenting as a Submucosal Cecal Mass

A wide variety of benign and malignant submucosal lesions may arise from the wall of the large intestine. They can originate in the submucosa or in the muscular propia; furthermore, they can be caused by compression of extrinsic structures.^1,2 We report a case of a submucosal mass identified as a fecalith protruding into the cecum.