Retained fecalith after laparoscopic appendectomy

Abstract

An intraabdominal abscess developed from a retained fecalith following laparoscopic appendectomy. We discuss the prevention and management of retained fecaliths in light of the numerous reports of retained gallstones.

Laparoscopic versus Open Appendectomy for the Treatment of Acute Appendicitis

“…There is a report of intra-abdominal abscess formation due to retained faecolith after laparoscopic appendectomy. It is strongly advised that the surgeons performing laparoscopic appendectomy should remove faecolith if found, and the stump of appendix should not big enough to contain any thing [11].…”

Dropped Appendicolith: Complications and Management

“…Retained, or dropped appendicolith is a rare complication that can occur as a consequence of stone expulsion from the appendix before surgery due to perforated appendix or during open or laparoscopic appendectomy [15] [16].…”

“…Sites where retained faecalith can be found are most commonly in the pelvis [17] or Morrison's pouch [16] [18]. In rare instances, the appendicolith has been localized in the iliopsoas compartment [19], gluteal region [20] or subcutaneous plane [21].…”

“…History of appendicectomy in the past will be present in most situations. The sites of abscess formation which are documented in the literature are subhepatic abscess [16][18] pelvic abscess [17], tubo-ovarian abscess [25], paracaecal [26], psoas abscess [19] and gluteal abscess [20][27].…”

“…Though this treats the abscess, it does not necessarily remove the appendicolith which is the root cause and nidus of infection. Thus in cases of retained appendicolith, the definitive management involves removal of the appendicolith [16] [21]. Failure to do so may result in recurrent intra-abdominal abscesses, wound infection and fistula formation [42].…”