Faecolith-induced small bowel obstruction: A rare acute surgical emergency - A case series

Intestinal obstruction is a common surgical emergency; however, faecolith-induced obstruction is exceptionally rare, especially in the small intestine. This case series highlights an uncommon etiology of small bowel obstruction(SBO), with an emphasis on diagnostic challenges, surgical management, and patient outcomes.

We report three cases of SBO due to faecolith impaction: two geriatric and one pediatric patient. All presented with symptoms of abdominal distention, colicky pain, and failure to pass stool. Imaging, particularly contrast-enhanced computed tomography (CECT) of abdomen and pelvis revealed dilated small bowel loops with transition point and intraluminal hyperdense masses suggestive of faecolith-induced SBO, including one case of secondary small bowel obstruction due to a caecal faecolith. Emergency Surgical interventions included enterotomy in two cases and cecotomy in one, with one patient requiring a loop ileostomy due to bowel edema. All patients recovered uneventfully and were discharged between postoperative day (POD) 5 to 8.

Faecolith-induced SBO is an uncommon but important differential diagnosis, particularly in patients with no prior history of abdominal surgery. In such case early imaging with CECT is crucial for diagnosis. Timely and appropriate surgical intervention results in excellent outcomes and helps prevent complications such as ischemia or perforation.

Clinicians should maintain a high index of suspicion for faecolith-induced SBO in patients with typical features of bowel obstruction but no history of prior abdominal surgery. Prompt diagnosis and operative management can lead to favorable outcomes.