A 60-year-old man who had been receiving dialysis for more than 30 years was admitted for treatment of
cellulitis in his right thigh on November 7, 2003. He suffered from an
ileus on December 14 and was found to have a huge, 7-cm-diameter, well-circumscribed
fecalith, incarcerated at the splenic flexure of the colon. It was proving difficult to pass this naturally and surgical removal was thought to be too risky. Using a
colonoscope and a water-jet probe, the
fecalith was broken up; the
ileus then improved and the patient was able to take oral fluids. Unfortunately, he died of
cardiac failure on February 13, 2004. We conducted an autopsy, with his family's consent, and found generalized
amyloidosis. Deposits of
amyloid were seen in all layers of the colon. Because of this, we hypothesized that peristalsis had been poor and this had led to
paralytic ileus due to stasis, which, in turn, had led to the formation of the huge
fecalith. In Japan it is not rare for a patient to be on dialysis for more than 25 years and it may be that this is a cause of generalized
amyloidosis. There have been no such cases of
fecalith associated with gastrointestinal
amyloidosis described previously, which is why we decided to report this case here.