Age/sex: 31-year-old male
Size: 11.1 x 4.9 x 4.9 cm
The appendix wall has been partly cut away to show a round, grey fecalith (F). The proximal part of the appendix (long arrow) that connects with the cecum is normal in size. The distal part (short arrows) is mildly dilated because of luminal obstruction by the fecalith. Despite the label “appendicitis”, the serosal surface of the appendix is smooth and it is not certain from the gross appearance that this was present.
Appendicitis and fecaliths
A fecalith is literally “a stone made of fecal matter”. It occurs when a small piece of stool loses water and hardens. Although it can develop in the colon, it is most common in the appendix. It can cause no symptoms or complications, as was likely the case with this specimen. However, in some individuals it leads to acute appendicitis, possibly by compressing the adjacent blood vessels and causing mucosal injury with subsequent invasion of bacteria into the appendix wall.
Acute appendicitis was first described in detail by the French physician Jean Fernel in his textbook Therapeutices Universalis in 1581. Additional descriptions were given by other authors over the years, including the following by Thomas Hodgkin (of lymphoma fame) in his Lectures on the Morbid Anatomy of the Serous and Mucous Membranes in 1836:
“The partial inflammation of the peritoneum, in the iliac fossa, is sometimes set up by disease in the Appendix caeci. If this be inconsiderable, it may merely give rise to some very limited partial adhesions; at other times, the Appendix having been perforated by ulcerations occasioned by the lodgement of the faecal concretions in its cavity, extravasation takes place, and inflammation of a more severe and serious kind is originated.”
Below: Portrait of Jean Fernel.
Source: Burgess, R. (1973). Jean Fernel. Line engraving. Wellcome Collection. https:// wellcomecollection.org/works/uddcwach
