Koprolith

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 .

Clinical presentation

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 . Rarely, more severe symptoms result from complications; anuria, obstructed labor, and nerve compression symptoms are among those previously reported in the literature .

Pathology

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 . 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 .

Fecoliths are associated with:

• chronic constipation
• inflammatory bowel disease
• Hirschsprung disease
• Chagas disease
• psychiatric disease
• elderly
• bedridden

Radiographic features

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 . If conservative management fails, colonoscopic management includes mechanical lithotripsy and water jet; only once complications are evident would surgical removal become the preferred management .

Complications

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
• diverticulitis
• bowel obstruction
• bowel wall perforation
• hydronephrosis
• bladder wall rupture
• uterine rupture 
• compression of neurovascular structures 

Siehe auch:

• Koprostase
• Morbus Hirschsprung
• röntgendichtes Material im Kolon
• Appendizitis
• chagas disease
• Koprolith in Meckel-Divertikel
• Kolitis bei impaktierter Fäzes
• Perforation bei Stuhlimpaktation

und weiter:

• inflammatorischer fibroider Polyp
• a polypoid mass in the ileum