Impact of CT-Detected Appendiceal Fecoliths on Clinical and Histopathological Outcomes in Acute Appendicitis: A...

Acute appendicitis is a common presentation in most emergency departments, and the presence of appendiceal fecolith on CT is indicative of earlier progression to complicated disease. This study aimed to assess the association between appendiceal fecoliths identified on preoperative computed tomography (CT) and the severity of appendicitis, using integrated clinical, radiological, surgical, and histopathological data.

We conducted a retrospective observational study of 529 adult appendicectomy patients diagnosed with acute appendicitis via CT between 2010 and 2020 at two tertiary hospitals in Sydney, Australia. Patients were stratified into two groups based on the presence or absence of an appendiceal fecolith on CT. Demographics, inflammatory markers, imaging features, operative findings, and histopathological outcomes were compared.

An appendiceal fecolith was identified on CT in 18.1% (n = 96) of patients. Baseline demographics and symptom duration were similar between groups. However, the fecolith group had significantly elevated inflammatory markers (CRP: 66.8 ± 9.0 vs. 45.5 ± 3.0 mg/L, p = 0.014; WBC count: 14.4 ± 0.4 vs. 12.4 ± 0.2 × 10⁹/L p < 0.001), greater appendiceal diameter on CT (12.8 ± 0.4 vs. 10.0 ± 0.2 mm, p < 0.001), and a higher incidence of perforation (28.1% vs. 8.8%, p < 0.001). Postoperative length of stay was also prolonged in the fecolith group (54.7 ± 4.6 vs. 42.4 ± 2.2 h, p = 0.008). Despite similar time to surgery, the fecolith group had more frequent complications.

The presence of an appendiceal fecolith on preoperative CT is strongly associated with increased disease severity, including higher rates of perforation, elevated inflammatory markers, and longer hospitalization. Clinicians should consider appendiceal fecoliths as a marker of complicated appendicitis and consider early surgical intervention in this subgroup.