ACG CASE REPORTS JOURNAL acgcasereports.gi.org ACG Case Reports Journal | Volume 3 | Issue 3 | April 2016 156 IMAGE | COLON Fecalith Causing Mechanical Bowel Obstruction Managed with Intracorporeal Lithotripsy Tan Attila, MD 1,2 , Burcak Kabaoglu, MD 3 , Tamer Koymen, MD 4 , and Zeynep Unal Kabaoglu, MD 5 1Division of Gastroenterology and Hepatology, Koc University School of Medicine, Istanbul, Turkey 2 Division of Gastroenterology and Hepatology, Amerikan Hastanesi, Istanbul, Turkey 3 Department of General Surgery, Amerikan Hastanesi, Istanbul, Turkey 4 Division of Internal Medicine, Amerikan Hastanesi, Istanbul, Turkey 5 Department of Radiology, Amerikan Hastanesi, Istanbul, Turkey Case Report An 87-year-old man with a past medical history of type II diabetes mellitus, pericarditis, peripheral vascular disease, and atrial fbrillation was admitted to the hospital with malnutrition, pneumonia, abdominal distention, and fecal incontinence. An abdominal computed tomography (CT) revealed an impacted calcifed fecaloid (6 x 10 cm) at rectum and dilated small and large intestines (cecum diameter 8.5 cm; Figure 1 and Figure 2). A rectoscopy showed a large fecalith causing a large ACG Case Rep J 2016;3(3):156-157. doi:10.14309/crj.2016.34. Published online: April 15, 2016. Correspondence: Tan Attila, MD, Amerikan Hastanesi, Guzelbahce Sokak, No 20, Nisantasi, Istanbul, Turkey (tanattila2003@yahoo.com). Copyright: © 2016 Attila et al. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0. Figure 1. Abdominal CT showing small and large intestinal obstruction caused by a calcifed rectal fecalith. Figure 2. Pelvic CT showing the rectal fecalith. rectal ulceration and distention of the proximal colon (Fig- ure 3). The rock-hard fecaltih could not be broken down and removed endoscopically. In the operation room, the fecalith was fragmented with an intracorporeal pneumatic/ ultrasound lithotriptor (Swiss Lithoclast; EMS Electro Medi- cal Systems SA, Nyon, Switzerland) introduced through the anal canal. The weight of the removed fecalith fragments was 190 g (Figure 4). Abdominal distention improved after removal of the fecalith.