Abstract
BackgroundSubmucosal fecalith(s) mimicking submucosal tumors of the gastrointestinal lumen are rare. Moreover, accurate preoperative diagnosis of these entities is exceedingly difficult, and the mechanism(s) of their formation remains unclear.Case presentationA 40-year-old woman visited the authors’ hospital due to lower abdominal pain and diarrhea. She had previously been treated for endometriosis. Laboratory investigation revealed increased C-reactive protein levels. Abdominal contrast-enhanced computed tomography revealed thickening of the appendix wall and dilation of the small intestine. The patient was diagnosed with paralytic ileus caused by appendicitis, and interval appendectomy was scheduled. She underwent laparoscopic-assisted appendectomy after conservative treatment. Partial cecal resection was selected due to the presence of an elastic mass in the cecum. The final pathological diagnosis was submucosal fecalith, not submucosal tumor. On day 5, the patient was discharged without any postoperative complications.ConclusionsIn cases of appendicitis with fecalith(s) that appear as submucosal tumor(s) on colonoscopy, submucosal fecalith mimicking submucosal tumor should be considered in the differential diagnosis.
Highlights
BackgroundAppendicitis with fecalith(s) is often encountered in clinical practice. The ratio of appendicitis cases with fecalith has been reported in different studies [1,2,3,4], some of which have reported an association between the appendix and fecalith formation, and that fecalith formation is associated with perforation in cases of acute appendicitis and the failure of conservative treatment [5,6,7]
Submucosal fecalith(s) mimicking submucosal tumors of the gastrointestinal lumen are rare
In cases of appendicitis with fecalith(s) that appear as submucosal tumor(s) on colonoscopy, submucosal fecalith mimicking submucosal tumor should be considered in the differential diagnosis
Summary
Appendicitis with fecalith(s) is often encountered in clinical practice. The ratio of appendicitis cases with fecalith has been reported in different studies [1,2,3,4], some of which have reported an association between the appendix and fecalith formation, and that fecalith formation is associated with perforation in cases of acute appendicitis and the failure of conservative treatment [5,6,7]. A few case reports [8,9,10,11,12,13,14,15,16,17,18] have described fecaliths mimicking submucosal tumor(s). The present report describes a case of appendicitis with submucosal fecalith mimicking a submucosal tumor. Case presentation A 40-year-old woman was admitted to the department of surgery at the authors’ hospital with complaints of lower abdominal pain and diarrhea. A mass similar to a submucosal tumor was found in the cecum near the appendix root (Fig. 3a). The postoperative course was uneventful, and the patient was discharged on postoperative day 5
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