Laparoscopic surgery assisted by colonoscopy for a submucosal cecal fecalith presenting as acute appendicitis

RATIONALE A cecal submucosal fecalith is extremely rare and is likely to be misdiagnosed as appendicitis with an incarcerated fecalith. PATIENT CONCERNS This review presents the case of a female patient complaining of recurrent abdominal pain in the right lower quadrant, similar to the clinical symptoms of appendicitis. Physical examination revealed an abdominal tenderness in the right lower quadrant without rebound tenderness or muscular tension. An ultrasound examination found a mass located in the right lower abdomen. Computed tomography showed a high-density shadow in the cecal cavity. DIAGNOSES A fecalith was detected in the submucosal cecal wall. The postoperative pathologic examination showed that the fecalith was located in the submucosa. INTERVENTIONS A partial cecal excision was performed under laparoscopic surgery assisted by colonoscopy. OUTCOMES The patient was discharged 1 week after surgery without postoperative complications. LESSONS Fecaliths should be considered in the differential diagnosis of submucosal occupying lesions of the cecum.