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Case Report
Impacted golf tee shaped appendiceal fecalith causing appendiceal non-visualization and mimicking cecal mass: A case report
1 Department of Pathology, Rush University Medical Center, Chicago, IL, USA
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Sindhuja Sivanandham
MBBS, 579 Jelke, 1620 W Harrison St, Chicago, IL 60612,
USA
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Article ID: 101347Z01SS2022
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Sivanandham S, Jakate S. Impacted golf tee shaped appendiceal fecalith causing appendiceal non-visualization and mimicking cecal mass: A case report. Int J Case Rep Images 2022;13(2):147–151.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.
Keywords: Appendicitis, Appendicolith, Cecal mass, Fecalith
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Acknowledgments
The authors would like to acknowledge the Department of Pathology at Rush University Medical Center for secretarial support.
Author ContributionsSindhuja Sivanandham - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Shriram Jakate - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Sindhuja Sivanandham et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
