Appendiceal faecaliths are associated with right iliac fossa pain

Abstract

There is debate over whether a normal-looking appendix should be removed at diagnostic laparoscopy performed for right iliac fossa (RIF) pain. Faecaliths are associated with appendicitis. This study assessed whether there was an association between the removal of normal appendices containing faecaliths and improvement of symptoms. Analysis of the histology database for all appendicectomies during 2003–2007 with normal histology, noting presence of a faecalith. Retrospective study using a telephone questionnaire for frequency/duration of pre-operative symptoms, postoperative symptom recurrence, re-admission rates and complications. The faecalith-positive (f⁺) group was compared to a similar control group of patients who had a normal appendix removed which did not contain a faecalith (f⁻). Out of 203 appendicectomies performed with normal histology, 26 (13%) were f⁺. Of these, 21 responded to the questionnaire. Thirty-one consecutive patients with normal histology and no faecalith were identified. A similar proportion in each group presented with three or more episodes of pain prior to appendicectomy (38% f⁺; 39% control). Only one (5%) of the f⁺ patients had recurring symptoms after the operation, compared with 14 (48%) of the control group (P = 0.0016). Only one (5%) of the f⁺ patients underwent further investigations, compared with 11 (36%) of the control group (P < 0.02). None of the f⁺ patients were re-admitted, compared to 19% of the control population. There were no significant postoperative complications in either group. Appendiceal faecaliths may be a cause of right iliac fossa pain in the absence of obvious appendiceal inflammation. In this study, the policy of routine removal of a normal-looking appendix at laparoscopy in the absence of any other obvious pathology appeared to be an effective treatment for recurrent symptoms in those cases with a faecalith. Further studies are needed to assess this putative association.