Can CT detect fecaliths in appendicitis?

In general, CT can clearly visualize fecaliths associated with appendicitis and is one of the commonly used and accurate imaging methods for diagnosing appendicitis complicated by fecaliths, especially offering advantages when ultrasound findings are inconclusive. The details are as follows:

Fecaliths in appendicitis refer to hardened fecal matter or calcified materials within the appendiceal lumen. Thanks to its high resolution, CT can identify the high-density shadows of fecaliths, accurately determining their location and size within the appendix and whether they are causing luminal obstruction. At the same time, CT allows simultaneous evaluation of the appendix itself—such as whether it is swollen, if the wall is thickened, and whether there is inflammatory exudate or fluid accumulation around the appendix. These findings help physicians determine whether the fecalith has triggered appendicitis and assess the severity of inflammation.

In cases where ultrasound examination is limited—such as in obese patients or when excessive intestinal gas interferes with ultrasound penetration—CT demonstrates greater diagnostic value, reducing the risk of missed or incorrect diagnoses. However, it should be noted that CT findings must be interpreted in conjunction with the patient’s clinical symptoms and laboratory tests (e.g., complete blood count); a diagnosis should not be based solely on CT results.

Therefore, when appendicitis with fecalith is suspected, CT is an important diagnostic option that provides critical information for clinicians to confirm the condition and formulate appropriate treatment plans.