Caecal faecolith, a cause of acute appendicitis

A 60-year-old woman presented to the accident and emergency department with a 3-day history of lower abdominal pain, which was sudden in onset, localised to the right iliac fossa, constant and aggravated by movements. On examination, she was febrile (100·F), tachycardic and normotensive. Examination of the abdomen revealed an ill-defined tender mass in the right iliac fossa. A clinical diagnosis of appendicular mass was made and treated conservatively. After a few days the mass became smaller, firmer, mobile and non-tender. Since the mass persisted, the patient was investigated further to rule out carcinoma of the caecum. A contrast-enhanced CT (CECT) of the abdomen showed a mass with air pockets in the caecum, suggestive of caecal faecolith. After 6 weeks, appendicectomy and removal of the faecolith were performed. The postoperative period was uneventful. Histopathology of the appendix showed inflammatory changes confirming appendicitis.