Caption: Figure 2: Resected specimen shows that the appendix contained a white, fragile fecalith
. There was inflammation at the tip of the appendix (a).
Caption: Figure 1: In CT images of the patient, bladder is not full enough but 2 cm hyperdense calculi are seen in posterior inferior part of bladder (curved arrow) and hyperdense fecalith
image is seen in right superior posterolateral part of bladder (arrow).
is a hard mass of dried body waste, or stool.
Our patient had no previous disorder creating any tendency for an appendiceal disease, and the clinical presentation was consistent with a newly occurring appendicitis 2 h after the colonoscopy procedure; we therefore suggest that our procedure cause the complication by forcing a fecalith
into the appendiceal lumen.
Acute fissure-in-ano is abrupt in onset and occurs most commonly due to trauma by a hard fecalith
. Marked spasm due to severe pain is usually the main complaint.
Generalized tenderness was assigned a score of 4 points; abscess on CT scan was 3 points; symptom duration longer than 48 hours was 3 points; a white blood count greater than 19,400 cells/[mm.sup.3] was 2 points; and fecalith
on CT scan was 1 point.
is seen on plain x-ray only 1% of the time.
The causes of the proximal appendiceal obstruction include fecalith
, epithelial hyperplasia, post-inflammatory fibrosis, cystadenoma, cystadenocarcinoma, carcinoid, and endometriosis.
(1) Stump appendicitis results from obstruction of the lumen of the remaining appendix, usually by a fecalith
. This increases intraluminal pressure, impairing venous drainage and allowing subsequent bacterial infection.
Although it is known that the factors that cause direct luminal occlusions, such as fecaliths
, lymphoid hyperplasia, tumor, and several infectious agents, such as Fusobacterium and Escherichia coli, cause appendicitis, the exact etiology is still unknown (4,5).
However, in some of these birds, consumption of large amounts of the substrate caused severe mechanical damage to the intestinal mucosa, leading to formation of intestinal caseous plugs, fecaliths
, and complete blockages.
or inflammatory hypertrophy of the lymph nodes is a major cause of proximal appendiceal lumen obstruction that may lead to impaired blood supply of the appendix followed by rapid multiplication of resident bacteria of the appendix and bacterial endotoxin release (8).