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THE RED SECTION

nature publishing group

Video of the Month Am J Gastroenterol 2014;109:1326; doi:10.1038/ajg.2014.290

Obstructive, calcified fecoliths. A 56-year-old woman with a history of long-standing Crohn’s disease and noncompliance, presented to the emergency department with acute and colicky abdominal pain. Colonoscopy and abdominal X-ray showed an ulcerative colonic stenosis with several hard fecoliths proximally in the transverse colon (left). Conservative therapy was attempted with adalimumab and dilation of the stenosis. One month later, the patient presented again with severe pain in the lower abdomen. An abdominal X-ray showed the fecoliths now located near the stenosis in the flexura lienalis (right; arrows) and a dilated bowel loop. The fecoliths were successfully removed with endoscopic mechanical lithotripsy using a biliary crusher (LithoCrushV, Olympus). The stones were so hard that several baskets were damaged (video). Reports of colonic obstruction secondary to impaction of a fecolith have been rare in the literature, but it should always be considered in the management of bowel obstruction. Fecoliths develop primarily in areas with intestinal stasis and calcify in an alkaline environment. Endoscopic lithotripsy seems to be an effective and safe procedure for removing large fecoliths. (Submitted by Florine M.L. Sandkuijl and Ellert J. van Soest, Kennemer Gasthuis, Haarlem, The Netherlands.)

To watch the Video of the Month, please visit AJG online: http://www.nature.com/ajg/journal/v109/n9/suppinfo/ajg2014290.htm

The American Journal of GASTROENTEROLOGY

VOLUME 109 | SEPTEMBER 2014 www.amjgastro.com

Video of the month : obstructive, calcified fecoliths.

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