appendicitis is mainly a disease of Western societies with lower fibre diets which result in harder, drier stools and is rare in traditionally living Africans and Indians.
it is thought that obstructing faecoliths may be an aetiologic factor especially in children although some studies appear to refute this 1)2)
if the feacolith remains present for a long time it may become calcified and be evident on AXR or CT scan
fecoliths in the appendix appear to be associated with development of appendicitis and if it does occur, increased risk of perforation at an earlier phase of the process
this is particularly true for paediatric population:
perforation rates were 57% with fecolith and 36% without fecolith
RIF pain and appendiceal faecoliths on imaging
this raises the probability of appendicitis as a cause of the pain, and if it is present then these cases are more likely to perforate before surgery
Incidental finding of appendiceal faecoliths with no RIF pain
many surgeons would consider elective surgery for appendectomy although the incidence of subsequent appendicitis without surgery does not seem high
the prevalence of incidental appendiceal faecoliths in adults undergoing abdominal surgery appears to be higher in Canada (32% - 37% if no 3 day preop-op bowel prep vs 17% with 3 day bowel prep) than in South Africa (4%) and this is presumed to be due to high fibre diets in Sth Africa being protective. Appendiceal faecoliths were found in 52% of patients with appendicitis in Canada and in 23% of appendicitis patients in Africa. 3)