An abdominal fecalith after laparoscopic appendectomy in a 6-year old girl

Introduction. A fecal stone, or fecalith, is often diagnosed in destructive appendicitis. It can pass into free abdominal cavity both before and during surgery. The incidence of fecaliths left after appendectomy is unknown, and there are only few cases reported in the literature. Abscess formation after appendectomy is a known and frequent complication, especially in case of perforated appendicitis; its incidence reaches 20%. A retained fecalith can trigger an intra-abdominal abscess in the postoperative period.

The purpose of the work is to demonstrate the need for a thorough revision and sanitation of the abdominal cavity during appendectomy in order to avoid leaving fecalitis. The technical features of laparoscopic appendectomy represent an increased risk factor for the development of such complications.

Description of clinical observation. This article describes a clinical case when a fecalith was found in the abdominal cavity after laparoscopic appendectomy. The patient was operated on for gangrenous-perforated appendicitis 3 months before the present admission to the hospital. After the performed surgery, from time to time the patient complained of periodic abdominal pain and subfebrile temperature. The child was thoroughly examined. Ultrasound and CT examination of the abdominal organs and retroperitoneal space revealed an abdominal abscess with a concrement in it. At laparoscopy, the abscess was opened; a free fecalith was found in it; it was removed.

Conclusion. The presented clinical case demonstrates the need to perform a thorough revision and sanation of the abdominal cavity during appendectomy, so as not to leave any fecalith in it. Laparoscopic appendectomy may have an increased risk factor for developing such complications.