[Faecolithiasis: straightforward to detect, but often missed].

Faecal impaction is a problem which is becoming more prevalent now that the number of elderly patients is increasing. When not detected and treated inadequately, it can lead to symptoms such as diarrhoea, faecal incontinence and other serious problems like anorexia, vomiting and rectal ulcers with bleeding or even a bowel perforation. We describe two patients with serious and less common complications of faecolithiasis. Patient A, a 79-year-old woman with signs of dementia, presented with faecal incontinence and unexplained worsening of her cognitive symptoms leading to a situation where she could no longer live in her own home. Patient B, a 52-year-old woman, presented with urinary retention, stomach ache and constipation, suggesting an obstructive tumour in the pelvis. In both patients a CT-scan showed no pathology. Neither of the patients responded to oral laxative treatment. Eventually, a faecolith was detected and treated through endoscopic inspection and fragmentation. Both patients recovered completely.