Dhanush Hoskere, DO1, Kovil Ramasamy, MD2, John Dedousis, MD3
1Bayonne Medical Center-CarePoint Health, Bayonne, NJ; 2Rowan University School of Osteopathic Medicine, Stratford, NJ; 3CarePoint Health, Bayonne, NJ
Introduction: Fecaliths are generally classified by the degree of calcification and presence of solid material in the stool. Fecaliths can cause complications such as hemorrhage, perforation, intussusception, and bowel obstruction. However, no documented cases of solid fecaliths associated with diarrhea exist.
Case Description/Methods: 63-year-old male with past medical history of hypertension, diabetes mellitus type II, gastroparesis, chronic kidney disease, and hyperlipidemia presented to the hospital with subjective fever, dull epigastric pain, belching, episodes of non-bloody bloody non-, bilious vomiting, and non-bloody diarrhea for 2 weeks. He denied any recent travel history, new food consumption, or alcohol use. On exam, patient had diffuse tenderness of the abdomen but did not have any guarding, rebound, or distension. Lipase and liver function tests were within normal limits. Abdominal CT revealed no evidence of bowel incarceration or obstruction. Colonoscopy was performed for further evaluation which showed a large polyp covered with stool prolapsing into the cecum. Stool was removed with irrigation, which exposed a solid egg-shell like calcification. The calcification was cold-snared to expose the normal colonic mucosa underneath and was subsequently removed. This egg-shell like calcification likely represented fecalith which had calcified around a mucosal fold in the cecum. After the endoscopy, patient’s symptoms improved, and he was discharged from the hospital.
Discussion: Fecaliths are common in clinical practice. The hardness of a fecalith is usually classified by the degree of calcification and presence of solid materials. Usually, fecaliths are managed conservatively with digital disimpaction, low residue diet, and administration of enemas and laxatives. Fecaliths can be broken down with colonoscopic methods such as a water jet or mechanical lithotripsy prior to removal. In this case, water jet only cleaned the liquid stool off of the calcified fecalith. This is one of the first cases reported using cold snare to break and dislodge calcified fecalith. It is also one of the first cases where fecalith was shaped around mucosa forming an egg-shell like calcification. In addition, fecaliths have been known to cause constipation through bowel obstruction; however, this case shows that there may also be an association with diarrhea as fecaliths may cause irritation of the mucosa leading to increased colonic transit. Further research will have to be done to assess for the validity of this theory.
Citation: Dhanush Hoskere, DO; Kovil Ramasamy, MD; John Dedousis, MD. P1102 - ATYPICAL PRESENTATION OF CALCIFIED FECALITH. Program No. P1102. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.