Intussusception of the appendix with a calcified fecalith

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.

Intussusception of the vermiform appendix

Appendicitis is a common presentation to an acute general surgical on call team. It can be a difficult diagnosis at times, particularly in sexually active young women, in whom it is often surgically challenging. This case is of a relatively straightforward diagnosis, taken for laparoscopic appendicectomy that resulted in performing an open right hemicolectomy for a necrotic, intussuscepted appendix. Histology ultimately revealed the cause of intussusception and resultant infarction of the appendix to be endometriosis.

Colonoscopic diagnosis of appendiceal intussusception in a patient with intermittent abdominal pain: A case report

Intussusception of the appendix is a rare condition. Most cases are diagnosed during operation of the patients suspected to have appendicitis. In this report we present a seventy one year-old man with a history of periumbilical intermittent abdominal pain for several months. None of the paraclinical tests were useful for determining the diagnosis. Colonoscopy performed during the last episode of abdominal pain revealed the prolapsed appendix in the cecum and the patient was sent to the operating room. Macroscopic appearance of the appendix was normal and microscopic examination revealed follicular hyperplasia and acute focal appendicitis. Appendiceal intussusception should be considered in differential diagnosis of intermittent abdominal pain and colonoscopic diagnosis could be very important to avoid dangerous or unnecessary decision making.