title: [Chronic appendicitis due to multiple fecaliths. A case report].
abstract: BACKGROUND
  The appendix inflammatory process is the most common cause of chronic abdominal pain in the right lower quadrant. The frequency of appendiceal lumen obstruction by fecalith ranges from 10 to 20%; few cases of obstruction by multiple fecaliths had been reported.
  
  
  METHODS
  Sixty-nine years old male, diabetic and hypertensive in control, he underwent bowel resection 30 years previously. He completed 6 months with intermittent, mild pain in the right lower quadrant abdomen; 14 days prior to admission with increasing pain, nausea, vomiting, constipation, abdominal distension and absence of peristalsis; 12,750 leukocytes, neutrophils 90%; plain abdominal radiography without specific bowel pattern, TAC with 3 dense images in right lower quadrant; exploratory laparotomy was performed and perforated appendix with 3 free fecaliths was found. Histopathological report showed fibrosis and lymphocytic infiltrate in the muscle layer of the cecal appendix consistent with chronic appendicitis.
  
  
  CONCLUSIONS
  The most common obstruction of the appendix lumen is by a single fecalith. In this case the patient had chronic appendicitis secondary to appendiceal lumen obstruction by multiple fecaliths. Reviewing the international literature any case of chronic appendicitis associated with the presence of multiple fecaliths was found.
authors.affiliation: Jefatura de División de Investigación, Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia, Instituto Mexicano del Seguro Social, Puebla, México. Electronic address: alvaro.montielj@imss.gob.mx.
authors.forename: Álvaro José
authors.initials: ÁJ
authors.lastname: Montiel-Jarquín
authors.affiliation: Servicio de Cirugía General, Hospital Guadalupe, Puebla, México.
authors.forename: Celso
authors.initials: C
authors.lastname: Ramírez-Sánchez
authors.affiliation: Jefatura de División de Investigación, Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia, Instituto Mexicano del Seguro Social, Puebla, México.
authors.forename: Eugenio
authors.initials: E
authors.lastname: García-Cano
authors.affiliation: Servicio de Cirugía General, Hospital Guadalupe, Puebla, México.
authors.forename: Nicolás
authors.initials: N
authors.lastname: González-Hernández
authors.affiliation: Servicio de Anatomopatología, Hospital General Regional Número 36, Instituto Mexicano del Seguro Social, Puebla, México.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Rodríguez-Pérez
authors.affiliation: Jefatura de División de Investigación, Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia, Instituto Mexicano del Seguro Social, Puebla, México.
authors.forename: Ivan
authors.initials: I
authors.lastname: Alvarado-Ortega
mesh_terms: D000368:Aged; D001064:Appendicitis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D002429:Cecal Diseases / Q000209:etiology; D002908:Chronic Disease; D005244:Fecal Impaction / Q000150:complications*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology; D008297:Male; D012008:Recurrence
keywords: Abdominal pain; Apendicitis crónica; Chronic appendicitis; Dolor abdominal; Fecalitos múltiples; Multiple fecaliths