Large ileal fecalith presenting as subacute obstruction and mimicking appendicitis: a case report

In patients with right lower quadrant pain post-appendectomy, consideration of alternative diagnoses is crucial. This case illustrates the rare presentation of a large ileal fecalith masquerading as constipation and McBurney's tenderness, emphasising the role of radiographic assessment in decision-making. Early diagnostic laparoscopy was instituted for a thorough survey of the abdomen for causes of fecalith. A single fecalith was identified 15 cm from the ileocolic junction while the rest of the bowel was normal. The 4×3.6 cm stone was retrieved by longitudinal enterotomy 10 cm proximal to the site of impaction followed transverse closure to prevent stricture formation. The extraction performed via minilaparotomy under laparoscopic guidance proved pivotal, leveraging the advantages of minimally invasive surgery and facilitating a swift recovery process.