[Postappendectomy abscess--the role of fecoliths].

Intraabdominal abscess formation is the most common septical complication after perforated appendicitis. An appendiceal fecalith favours appendicitis and is a high risk for complications like perforation or abscess formation. In a 6 year period 554 patients have been treated operatively for appendicitis in our institution. In 4 patients, 6 to 12 1/2 years, operated for perforated appendicitis, a fecalith was initially overlooked. This unrecognised fecalith at operation led to an intraabdominal abscess 14 days up to 17 months postoperatively. After laparatomy with extraction of the fecalith, drainage of the abscess and antibiotical therapy all patients attained definitive healing. An appendicolith can escape into the abdominal cavity before or during appendectomy, causing complications. An unrecognised fecalith is a rare cause for intraabdominal abscess formation. Nevertheless in patients with an intraabdominal abscess after appendectomy a thorough radiological search for a fecalith by means of plain abdominal radiograph and abdominal ultrasound is mandatory. Surgical removal of the intraabdominal fecalith is the only way to definitive healing.