Surgical Management of Fecaliths
A colorectal surgeon is the appropriate specialist to remove fecaliths, particularly when surgical intervention is required. 1
Specialist Designation
Colorectal surgeons with IBD experience and appropriate training should manage fecalith removal, especially when complications arise or when the fecalith is associated with inflammatory bowel disease, appendicitis, or colonic pathology 1
General surgeons may also perform fecalith removal in emergency settings, particularly when fecaliths cause appendiceal perforation or acute abdominal emergencies 1, 2
Clinical Context and Surgical Approach
When Fecaliths Require Surgical Removal:
Appendicular fecaliths causing acute appendicitis with perforation require emergency appendectomy by a general or colorectal surgeon 1, 2
Fecaliths causing colonic obstruction or perforation necessitate segmental colectomy or primary repair by a colorectal surgeon 1, 2
Migrated fecaliths causing complications (such as iliopsoas abscesses) require surgical removal by the appropriate specialist based on anatomic location 3
Non-Surgical Management Options:
Endoscopic removal is increasingly preferred for accessible fecaliths in the rectum, rectal stump, or sigmoid colon, performed by gastroenterologists with advanced endoscopic skills 4, 5
Conservative management with enemas and laxatives may be attempted first for uncomplicated cases, though surgical management prevents recurrence 2, 5
Multidisciplinary Considerations
Joint decision-making between gastroenterology and colorectal surgery is recommended for complex cases, particularly in patients with inflammatory bowel disease 1, 6
Patients with Crohn's disease and perianal complications require particularly careful surgical planning with experienced colorectal surgeons due to impaired tissue healing and infection risk 7
Key Clinical Pitfalls
Do not delay surgical consultation when fecaliths cause obstruction, perforation, or peritonitis—these are surgical emergencies requiring immediate intervention 1, 2
Colorectal surgeons demonstrate lower morbidity and mortality compared to general surgeons for complex colorectal procedures, making subspecialty referral important for elective or complex cases 1
Fecaliths in rectal stumps after Hartmann procedures can be managed endoscopically by experienced gastroenterologists, avoiding unnecessary surgery 4