Chronically Retained Fecalith following Laparoscopic Appendectomy

Abstract

Background: Abscess formation because of retained fecalith is a recognized complication of appendectomy. These abscesses may present at a time remote from the appendectomy. No peri-hepatic abscess attributable to a retained fecalith has been reported more than four years following appendectomy. Methods: A 43-year-old male presented with a subhepatic abscess 9 y following appendectomy. A retained appendicolith was recognized immediately following appendectomy, but was not removed. At his return 9 y after the initial operation, a trial of antibiotic therapy was unsuccessful and he underwent an operation to drain the abscess and retrieve the fecalith. We review the literature pertaining to management of a retained fecalith following appendectomy. Results: Successful management of a subhepatic abscess attributable to a retained fecalith 9 y following appendectomy. Conclusions: Abscesses attributable to a retained fecalith may present many years following appendectomy. In this setting, antibiotic therapy alone without removal of a retained fecalith is unlikely to be successful.

Retained fecalith following laparoscopic appendectomy

“…There have been different recommendations for the management of a retained fecalith. 1,10 Black et al 4 presented a case of an abscess with fecalith adequately managed with intravenous antibiotics only. Some studies suggest percutaneous drainage and extraction of fecalith.…”

“…4,10 Despite these, surgical removal of fecalith is recommended by many surgeons. 1 We had two rationales for a right lateral hip approach instead of intra-abdominal approach. Firstly the location of the abscess was continuous from subcutaneous plane to intra-abdominal plane.…”

“…Laparoscopic appendectomy is currently the first choice of surgical approach for an acute appendicitis due to lower rate of surgical site infections, shorter hospital stay, and better cosmetic outcome. [1][2][3] Furthermore, an interval appendicectomy is favored by many surgeons for treatment of perforated appendicitis. However, one of the complications from laparoscopic appendectomy includes intra-abdominal abscess formation secondary to retained fecalith.…”

“…However, one of the complications from laparoscopic appendectomy includes intra-abdominal abscess formation secondary to retained fecalith. 1,4 Although rare, a dropped fecalith can occur during appendectomy or due to expulsion from perforated appendix. We present a case of recurrent intra-abdominal abscesses from a retained fecalith in the intramuscular layers of the iliacus in a patient whose initial diagnosis of an acute appendicitis was delayed.…”

“…Furthermore, an interval appendicectomy is favored by many surgeons for treatment of perforated appendicitis. However, one of the complications from laparoscopic appendectomy includes intra‐abdominal abscess formation secondary to retained fecalith 1,4 . Although rare, a dropped fecalith can occur during appendectomy or due to expulsion from perforated appendix.…”