Coprolite K56.4

A coprolite is a stone-like structure of intestinal contents, the core of which consists of thickened feces surrounded by encrusted mucus interspersed with intestinal contents (Roche 2003).

Constipation mainly affects older people, preferably in hospitals or care facilities. The percentage is around 70% and mainly affects women (Setya 2023).

Coproliths can develop in:

• Chronic constipation (Roche 2003)
• megacolon
• Disorders of intestinal peristalsis
• Relaxation of the rectal muscles
• Excessively dry diet
• Lack of exercise
• Medication, e.g. administration of opioids (Möller 2022) or long-term therapy with neuroleptics (Logre 2020)
• Due to stenoses in colon carcinomas (Möller 2022)

If hardened stools cannot be evacuated by regular peristalsis and this is not treated early, coproliths may form (Setya 2023).

The constant contact between the colonic mucosa and hard stool can cause increased mucus secretion. In addition, the intraluminal pressure in the colon increases, which leads to reduced blood flow to the colonic mucosa, which in turn can lead to local inflammation of the mucosa. Ulcerations and perforations can be the result (Setya 2023).

Coproliths preferentially develop in the colon, as this is where water is extracted from the intestinal contents. They are therefore found more frequently in the appendix, in any diverticula of the colon and in the ampulla recti (Roche 2003).

• Chronic constipation

alternating with

• thin, foul-smelling diarrhea, as liquid stool sometimes passes alongside a fecal stone as so-called paradoxical diarrhea (Merger 1999).
• Abdominal pain
• Tenesmus (Möller 2022)

Physical examination

On physical examination, a large rock-hard mass may be palpable in lean patients, particularly in the lower abdomen (Merger 1999). The abdomen is often distended (Setya 2023).

On rectal examination, the coprolith can sometimes be palpated (Möller 2022).

General view of the abdomen

In the native image, coproliths appear as inhomogeneous radiopaque structures (Werner 2020).

Abdominal sonography

This can provide possible indications of stenosis (Möller 2022).

CT of the abdomen

CT is the most commonly used radiological imaging method. It is performed with oral or rectal administration of contrast medium (Setya 2023).

• Tumor (Herold 2025)

• Ileus (Werner 2020)
• Fecal abscess
• Intestinal perforation (Roche 2003)
• Appendicitis: In the presence of a fecal stone in the appendix, appendicitis can develop via a bacterial infection of the intestinal wall (Bünte 2004).
• Copremia, a so-called autointoxication in which intestinal bacteria pass through the intestinal wall (Möller 2022)
• Compression of the urinary bladder with urinary retention (Setya 2023)

• In acute cases, we recommend:

Distal obstruction

In the case of fecal stones in the ampulla recti, digital evacuation is recommended (Möller 2022). This should be carried out with sufficient lubricant. The use of an anoscope and suction can also be supportive (Setya 2023).

Proximal obstruction

Suppositories or enemas can be helpful for coproliths located further proximally.

Enema:

The enema should consist of copious amounts of water with docusate or sorbitol and is best done with a Foley catheter that can be passed past the hardened feces. Only small amounts should be introduced to prevent discomfort to the patient. This procedure should be repeated several times after the evacuation process (Setya 2023).

Very proximally located coproliths

For very proximally located coproliths, oral polyethylene glycol administered over several hours in a volume of 1-3 liters has proven effective. If abdominal cramps or nausea occur, the intake should be stopped (Setya 2023).

Magnesium citrate is another laxative for coprolites located far proximally (Setya 2023).

If digital evacuation and enemas do not result in bowel evacuation, surgical manual decongestion is ultimately indicated (Setya 2023).

Constipation is the cause of increased morbidity. If it progresses, it can lead to complications that can sometimes be fatal in older people (Setya 2023).

Patients should be made aware of the need for stool regulation through a high-fiber diet and adequate fluid intake (Möller 2022) Patients should be made aware of the need for stool regulation through a high-fiber diet and adequate fluid intake (Möller 2022).

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