Chronic Abdominal Pain: A Case of Giant Fecalith in the Distal Jejunum

Abstract

A fecalith is a mass of an accumulation of hardened fecal matter that is seen in patients with Chagas disease, Hirschsprung's disease, and inflammatory bowel disease. In this article, we report a case of a 53-year-old female with chronic abdominal pain who was admitted with progressive weight loss, near syncope episode, and serum potassium of 2.6 mg/dL. An abdominal computed tomography (CT) scan revealed a left lower quadrant complex mass measuring 10.3 cm, with asymmetrical wall thickening and inflammatory stranding, nondiscarding the compromise of the small bowel and consequent mild small bowel distention. A fecalith of 10.3 x 10.9 x 8.7 cm was found during an exploratory laparotomy in the small intestine. We report this rare case of distal jejunum fecalith accompanied by chronic pain.

Like a Rolling Stone: Year-Over-Year Growth of a Rectal Fecalith

“…Chronic constipation and anatomic or functional anorectal abnormalities can result in the accumulation of hardened feces and the development of fecaliths [ 3 ], most commonly in the rectum and sigmoid colon [ 1 ]. The time required for the formation of large fecaliths is unknown.…”

“…Large fecaliths are often made up of multilayered calcified concentric structures [ 3 , 4 , 9 , 10 ], similar to the annual rings found on the cut surfaces of natural pearls [ 14 , 15 ] and trees, suggesting that their growth rates are not constant. Since the growth rate of pearls and trees is primarily influenced by seasonal temperature, the multilayered structures follow an orderly and repetitive annual pattern [ 16 , 17 ].…”

“…The pathophysiology of fecalith formation is usually associated with decreased peristalsis in the lower gastrointestinal tract, dehydration, and consumption of a low-fiber diet [ 2 ]. The inability to pass stool for a prolonged period can lead to the formation of fecaliths due to the hardening of fecal material that forms a mass separate from other bowel contents [ 1 , 3 , 4 ]. Fecaliths in the appendix are called appendicoliths, and they often complicate appendicitis [ 5 ].…”

Delayed Presentation of a Retained Fecalith

“…Fecal impaction occurs when a large amount of fecal matter gets compacted and cannot get evacuated spontaneously [ 1 ]. In its extreme form, fecal impaction can lead to the formation of a fecalith due to the hardening of fecal material that forms a mass separate from other bowel contents [ 2 ].…”

“…It can occur in any part of the intestine [ 1 ]. Most often, a fecalith arises in the colon (mostly sigmoid) or rectum and very rarely in the small intestine [ 2 ].…”