Fecal stones

Fecal stones are dense formations that in some cases form in the colon from its contents. Most often occur in the elderly and senile age. Predisposing factors are long-term stasis of intestinal contents caused by hypotension or atony of the colon, dysfunction of the colon in Parkinson's disease, congenital anomalies of it in the form of megacolon, Hirschsprung's disease, additional loops.

Causes of the fecal stones

Fecal stones occur in old and old age. Predisposing factors are long-term stasis of intestinal contents, caused by hypotension or atony of the colon, dysfunction of the colon in  Parkinsonism,  congenital anomalies of  it in the form of  megacolon,  Hirschsprung's disease, additional loops.

The most important factor contributing to the formation of fecal stones of the colon from its compacted contents is the intensive absorption of water, the slow movement of the contents and the formation of feces. The contents of the small intestine, coming from the stomach, are liquid, and its passage through the intestines is carried out quickly.

Sometimes a stone, which is closely adjacent to the mucous membrane of the colon wall for a long time, is “stoned”, which contributes to its fixation in a given place.

[1], [2], [3]

Pathogenesis

Fecal stones can be single and multiple, they are usually round or oval in shape, with a diameter of up to 8-15 cm. A. Mopgo (1830) described an intestinal stone weighing 4 pounds (about 1.9 kg). Intestinal stones have a dense, sometimes very hard texture, which made it possible to call them stones.

Colon stones consist of compacted feces, sometimes have an admixture of mucus; in a section, in some cases, they have a layered structure (concentric layers are visible). Sometimes fecal stones are formed around the “core”, which can be randomly swallowed and entered into the intestine bone berries, pieces of meat or chicken bones, unchewed and undigested dense pieces of food, conglomerates formed from poorly digestible dietary fibers, swallowed hair, gallstones, large tablets poorly soluble drugs and many other foreign bodies. In some cases, the occurrence of intestinal stones can cause large doses of insoluble antacids.

Stones consisting almost exclusively of magnesium carbonate alone are described, as well as stones containing 80% lime carbonate or “fatty-wax mass”, apparently resulting from excessive consumption of very fatty foods containing refractory fats of animal origin, or insufficient digestion of fats.

In some cases, fairly large gallstones enter the intestines through fistulous messages of the gallbladder with the intestines (usually with a transverse colon ) and even urinary stones that have fallen into the intestines through the fistulous passages of the renal pelvis or bladder.

[4], [5], [6], [7], [8], [9], [10], [11], [12]

Symptoms of the fecal stones

Spastic abdominal pain is possible, sometimes ulceration of the intestinal wall, which can be the cause of intestinal bleeding. Large fecal stones can cause intestinal obstruction.

The course of the process in a certain period of time (sometimes very long) is asymptomatic or oligosymptomatic, in other cases it is relatively early complications.

[13], [14], [15], [16]

Complications and consequences

One of the main complications is the occurrence of obstructive (partial or complete) intestinal obstruction. Usually a spastic component plays a known role in the development of this complication. The literature describes 6 rare cases of intestinal obstruction when taking large doses of insoluble gel antacids. Intestinal bleeding due to the formation of pressure sores and ulceration of the intestinal wall at the site of adhesion and constant pressure of the intestinal stone. In rare cases, with the prolonged existence of the stone and cicatricial-inflammatory changes in the intestinal wall at the site of its abutment, intestinal stenosis with time forms.

[17], [18], [19]

Diagnostics of the fecal stones

Diagnosis of fecal stones is often difficult. Large stones, especially of the colon, can sometimes be determined using the method of deep palpation. In this case, seals along the colon, especially in persons suffering from spastic constipation, can often be detected during palpatory examination. When a persistent limited compaction is detected in a patient with palpation of the abdomen or when a “filling defect” is detected during an X-ray examination of the intestine, one should first think of a malignant intestinal tumor. If this formation is localized in the colon - about cancer, especially since the cancerous lesion of the colon is much more common. A number of additional symptoms - slight pain in the abdomen, loss of appetite, varying degrees of weight loss, mainly elderly patients, accelerated ESR - also suggest tumor lesion of the intestine, although they can be caused by completely different reasons. An additional examination provides an opportunity to clarify the diagnosis: a survey X-ray of the abdomen and an echography allows to identify calculi containing calcium salts. With the localization of education in the colon, the correct diagnosis can be made with sigmoid or colonoscopy. 

[20], [21], [22]

Differential diagnosis

 Differential diagnosis of fecal stones should also be carried out with benign tumors,  intestinal polyps.

[23], [24]

Treatment of the fecal stones

If the diagnosis of fecal stones is established, laxatives  (in the hospital) and siphon enemas (for colon stones) are prescribed for cleaning . If the stone has descended into the rectum, it can be removed with a finger during its examination or, if necessary, with the help of surgical instruments.

With the development of obstructive  intestinal obstruction  , surgery is necessary.