Appendicular and Caecal Fecalith causing Perforation: A Case Report

Fecalith is a concretion of dry compact feces or hard stony mass of faeces in the intestinal tract. Thoughappendicular fecoliths are commonly encountered, caecal fecoliths are rare entities. Fecoliths areamenable to conservative management with laxatives and enemas but surgical management preventsrecurrence. We present a case of 27 years old male who was diagnosed with acute appendicitis withperitonitis. He was intraoperatively diagnosed as gangrenous and perforated retrocaecal appendixwith multiple small fecaliths and a large fecalith on cecum with perforation. Appendectomy andprimary repair of caecal perforation done. Histological examination of perforated margin confirmedas an inflammatory lesion.

An unusual case of caecal perforation following ileostomy reversal

A 63-year-old man with a history of gastro-oesophageal reflux disease underwent defunctioning loop ileostomy for obstructing metastatic rectal cancer prior to receiving long-course neoadjuvant chemoradiotherapy. Four months post completion of neoadjuvant therapy, he underwent an uncomplicated elective ultra-low anterior resection with formation of colonic J pouch and first stage liver metastasectomy for bilobar liver disease. At 1 year, he proceeded to an elective closure of loop ileostomy. Unfortunately, his postoperative course was complicated by profuse diarrhoea with subsequent colonic perforation, necessitating an emergency laparotomy and ileocolic resection with end ileostomy formation. Histopathology and stool studies were consistent with Salmonella Typhi infection. At the present time, Salmonella Typhi causing toxic megacolon and subsequent colonic perforation is an uncommon phenomenon in Australia. Here, we present an unusual case and explain why bowel perforation in this instance likely had a multifactorial aetiology.