A fecolith, also known as a coprolith or stercolith, is a stony mass of compacted feces. They are most common in the descending and sigmoid colon, but may also form in the small bowel or appendix 1,2.
Fecoliths differ in their presentation based on size and location and may first be detected with the occurrence of severe complications. Initial symptoms commonly include pain due to the partial or complete obstruction of a lumen; constipation is common but may be disguised by the presence of overflow diarrhea 3. Rarely, more severe symptoms result from complications; anuria, obstructed labor, and nerve compression symptoms are among those previously reported in the literature 4-10.
Fecoliths occur in severe cases of stool stasis with fecal impaction and form around a nidus in layers which may contain calcification visible on radiographs 2. Triggers for their formation are unknown but may include ingested foreign bodies or gallstones. Rarely, a fecolith may become very large and form a fecaloma with mass effect on surrounding structures 3.
Fecoliths are associated with:
- chronic constipation
- inflammatory bowel disease
- Hirschsprung disease
- Chagas disease
- psychiatric disease
On ultrasound, a fecolith may be visualized in the appendix, where it will cast an acoustic shadow. On abdominal radiograph or CT, the radiopaque fecolith may appear laminated due to layers of calcification.
Treatment and prognosis
The treatment of fecaliths is usually conservative; a low-residue diet, manual disimpaction, and aperients in oral or enema form are frequently used 10. If conservative management fails, colonoscopic management includes mechanical lithotripsy and water jet; only once complications are evident would surgical removal become the preferred management 3,10.
Complications of fecolith or fecaloma are rare but commonly result from obstruction, compression or erosion of the bowel or surrounding structures. Case reports have documented the following complications:
- appendicitis 4
- diverticulitis 5
- bowel obstruction 6,10
- bowel wall perforation 7
- hydronephrosis 8
- bladder wall rupture 9
- uterine rupture
- compression of neurovascular structures
- 1. Gutierrez E, Montelongo D, Gamboa E, Varon J, Surani S. Chronic Abdominal Pain: A Case of Giant Fecalith in the Distal Jejunum. (2020) Cureus. 12 (3): e7468. doi:10.7759/cureus.7468 - Pubmed
- 2. Obokhare I. Fecal impaction: a cause for concern?. (2012) Clinics in colon and rectal surgery. 25 (1): 53-8. doi:10.1055/s-0032-1301760 - Pubmed
- 3. Nigar S, Sunkara T, Culliford A, Gaduputi V. Giant Fecalith Causing Near Intestinal Obstruction and Rectal Ischemia. (2017) Case reports in gastroenterology. 11 (1): 59-63. doi:10.1159/000455186 - Pubmed
- 4. Ramdass MJ, Young Sing Q, Milne D, Mooteeram J, Barrow S. Association between the appendix and the fecalith in adults. (2015) Canadian journal of surgery. Journal canadien de chirurgie. 58 (1): 10-4. doi:10.1503/cjs.002014 - Pubmed
- 5. Onur MR, Akpinar E, Karaosmanoglu AD, Isayev C, Karcaaltincaba M. Diverticulitis: a comprehensive review with usual and unusual complications. (2017) Insights into imaging. 8 (1): 19-27. doi:10.1007/s13244-016-0532-3 - Pubmed
- 6. Yoo HY, Park HW, Chang SH, Bae SH. Ileal Fecaloma Presenting with Small Bowel Obstruction. (2015) Pediatric gastroenterology, hepatology & nutrition. 18 (3): 193-6. doi:10.5223/pghn.2015.18.3.193 - Pubmed
- 7. Arana AE, Arana CsH, Arana CV, Arana LN, Arana GaVA, Arana SSL, Arana. Giant faecaloma causing perforation of the rectum presented as a subcutaneous emphysema, pneumoperitoneum and pneumomediastinum: a case report. (2007) European journal of emergency medicine : official journal of the European Society for Emergency Medicine. doi:10.1097/MEJ.0b013e3282004952 - Pubmed
- 8. Caiazzo P, De Martino C, Del Vecchio G, Di Lascio P, Marasco M, Laviani F, Tramutoli PR. Megacolon for a giant faecaloma with unlucky outcome: case report and review of the literature. (2013) Annali italiani di chirurgia. 84 (3): 319-22. Pubmed
- 10. Attila T, Kabaoglu B, Koymen T, Unal Kabaoglu Z. Fecalith Causing Mechanical Bowel Obstruction Managed with Intracorporeal Lithotripsy. (2016) ACG case reports journal. 3 (3): 156-7. doi:10.14309/crj.2016.34 - Pubmed
- 9. Chute DJ, Cox J, Archer ME, Bready RJ, Reiber K. Spontaneous rupture of urinary bladder associated with massive fecal impaction (fecaloma). (2009) The American journal of forensic medicine and pathology. 30 (3): 280-3. doi:10.1097/PAF.0b013e318187e085 - Pubmed