Fecalith of appendix

A 8 year old boy presented with pain right lower abdomen, vomiting and fever .Abdominal examination revealing tenderness in right iliac fossa, with positive rebound tenderness and Rovsing's sign.X- ray abdomen was normal. Ultrasonography showed a non compressible tube like structure in the right lower quadrant and the positive probe tenderness suggestive of appendicitis. The patient underwent appendectomy. There was large fecalith 4.1×1.2×1 centimeter present near base. Histopathology was consistent with appendicitis.

Figure 1: showing appendix with fecalith

Fecalith associated appendicitis is obstructive appendicitis. The appendicolith or coprolith are calcified deposits within lumen of appendix. About 30% of children having appendicitis have associated fecalith. Sometimes it is an incidental finding but when associated with abdominal pain ,there is a 90% probability of having appendicitis and 50% have increased risk of perforation of appendix. Giant fecaliths are rarely seen.