Impacted golf tee shaped appendiceal fecalith causing appendiceal non-visualization and mimicking cecal mass: A case report

Abstract

Introduction: When fecaliths occur in the appendix, they commonly cause obstruction and bacterial overgrowth leading to appendicitis presenting as right lower quadrant pain. Fecaliths can be identified radiographically, and their presence raises high suspicion of appendicitis in the right clinical setting. Case Report: A 25-year-old Caucasian male presented with persistent lower abdominal pain, which was suspected to be a cecal mass on colonoscopy. Radiography by X-ray and computed tomography (CT) scan described a non-visualized appendix and no evidence of a fecalith. Colonoscopy was performed, and biopsies revealed an inflamed colonic mucosa with fecalith-like material. Subsequent right hemicolectomy revealed no cecal mass but an impacted golf tee shaped appendiceal fecalith which caused neither obstruction nor appendicitis due to its unique structure. Conclusion: This case report describes an appendiceal fecalith that grew in the form of a golf-tee starting at the tip, growing to the appendiceal orifice, and deviating from every known clinical and radiographic presentation of appendiceal fecalith with unusual pathogenesis. Specifically, this uncommonly shaped fecalith rendered the appendix difficult to visualize radiographically, mimicked a cecal mass on coloscopy, and caused persistent lower abdominal pain, in the absence of obstruction and without leading to appendicitis. This novel presentation widens the spectrum of appendiceal pathologies and clinical signs and symptoms that may be caused by a fecalith.