Plain films of the abdomen will demonstrate a fecalith in approximately 14% of patients with acute appendicitis.
Fluid in the right paracolic gutter, abscess formation (a liquefied mass of <20 HU on CT), or an inflammatory mass (indurated soft tissue of >20 HU on CT) with a calcified fecalith may be seen.
It shows significantly dilated air and fecal filled bowel loops with fecaliths
Obstruction of the appendix caused by lymphoid hyperplasia and fecaliths
is considered to be the most common cause of acute appendicitis.
One is elevated intestinal pressure as a sequela of luminal obstruction caused by inflammation, mucosal hyperplasia, or intestinal lesions such as fecaliths
, endometriosis, diverticula, and polyps.
Thus, in a lower-court case in which the plaintiff suffered a perforated bowel purportedly from the use of cholestyramine and codeine that resulted in severe constipation from huge fecaliths
, the doctor defendant escaped liability because the patient fared to exclude a barium enema procedure as the cause of the perforation.
While calcified appendicoliths are frequently discussed with appendicitis, lymphoid hyperplasia and fecaliths
are also common causes of appendiceal obstruction.